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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604207
Report Date: 12/12/2024
Date Signed: 12/12/2024 10:03:32 AM

Document Has Been Signed on 12/12/2024 10:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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:
12/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Ali Jaouhar TIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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Licensing Program Analysts (LPAs) Arian Golbakhsh and Angelica Boyles conducted an unannounced health and safety visit to the temporary facility location, Liberty Tranquility at 1404 Ash Street, Ramona CA 92065 for one of the clients at Liberty Harmony. The facility's permanent location is temporarily closed due to a planned power outage in the area, and one of the residents was moved to this location and the others to an Airbnb location.

LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to home lead Ali Jaouhar. LPAs conducted a tour of the facility and ensured the health and safety of the temporary resident. LPAs confirmed that resident's medications were kept in a safe and locked area, inaccessible to clients. No records were collected during the visit. LPAs did not observe any health or safety concerns.

No deficiencies were cited during the inspection. An exit interview was conducted with Nursing Manager Andrew Mossett, to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Their signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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