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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604207
Report Date: 05/21/2024
Date Signed: 05/21/2024 02:58:33 PM

Document Has Been Signed on 05/21/2024 02:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LIBERTY HARMONYFACILITY NUMBER:
374604207
ADMINISTRATOR/
DIRECTOR:		MANIPON, CHERIFERFACILITY TYPE:
737
ADDRESS:2915 DUCK POND LANETELEPHONE:
(760) 975-7176
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 4CENSUS: 4DATE:
05/21/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Cassandra FilsaimeTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced quarterly Case Management/Legal Non-Compliance visit. LPA was granted entry by and disclosed the purpose of the visit to Cassandra Filsaime, Lead BSP. LPA also spoke with Director of Quality Assurance and Training, Morgan Davis, via telephone.

The facility currently operates under a probationary facility license, the result of a Stipulation and Waiver; and Order (SW&O), which was effectuated on 8/22/2022. During today’s visit, LPA conducted a general overall inspection of the facility, interviewed staff, reviewed records, and evaluated licensee’s ongoing compliance with the requirements described in the SW&O.

During the visit, the facility was clean, safe, and in good repair. Records reviewed were current. There were no immediate health or safety concerns. Based upon today’s observation and interviews, the facility was operating consistent with the terms of the SW&O. No deficiencies were observed or issued as part of this compliance visit.

An exit interview was conducted with Cassandra Filsaime, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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