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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 10:52:13 AM

Document Has Been Signed on 12/12/2024 10:52 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: 3DATE:
12/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Katerina FosiTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs) Angelica Boyles and Arian Golbakhsh conducted a health and safety visit to the temporary facility location, 13826 Northcrest Lane Poway, California 92064. The facility's permanent location is temporarily closed due to a planned power outage. Three residents were relocated to this residence and one was relocated to Liberty Tranquility. LPAs were welcomed by, and identified themselves to, morning lead, Katerina Fosi and discussed the purpose of the visit.

LPAs conducted a tour of the facility and spoke with residents and staff. All medications for residents were locked and safely stored. 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 morning lead, Katerina Fosi to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
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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