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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604233
Report Date: 06/14/2022
Date Signed: 06/14/2022 01:43:51 PM

Document Has Been Signed on 06/14/2022 01:43 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:TARLETON HOUSEFACILITY NUMBER:
374604233
ADMINISTRATOR:OUIDIANI, CHEDLIAFACILITY TYPE:
735
ADDRESS:1650 TARLETON STTELEPHONE:
(619) 323-0804
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 6CENSUS: 6DATE:
06/14/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Cesiah Serrano, House ManagerTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA), Tiffany Holmes conducted an unannounced case management visit. LPA Holmes introduced herself and was allowed entry into the facility and explained the purpose of the visit to Cesiah Serrano, House Manager.

Today’s visit was regarding client health checks. During today’s visit LPA toured the facility inside and out and observed the clients in the facility. The house manager provided LPA with the info on where the clients were relocated to from the other house and for the two that were relocated to this facility.

An exit interview was conducted with Cesiah Serrano, House Manager A copy of this report, and the Licensee/Appeal Rights (9058 01/16) were provided to house manager.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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