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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604401
Report Date: 04/15/2024
Date Signed: 04/15/2024 02:50:20 PM


Document Has Been Signed on 04/15/2024 02:50 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:CASA DEL MANANA LLCFACILITY NUMBER:
374604401
ADMINISTRATOR:HERNANDEZ, CRISTINAFACILITY TYPE:
735
ADDRESS:1190 5TH AVE., #B3TELEPHONE:
(619) 841-4753
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 0DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Christina HernandezTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Administrator Cristina Hernandez with whom LPA discussed the purpose of the visit.

According to the facility’s license, the facility has a maximum capacity of four (4) ambulatory mentally disabled adults. During today’s inspection, there were no clients in care.

LPA, accompanied by the Administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant at 70.3F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 109.1F, downstairs bathroom sink was 112.3F, upstairs bathroom sink 111.1F and master bathroom sink 1 108.4F and sink 2 111.7F.


There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire

continued on LIC 809 page 2
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619( 767-2351
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CASA DEL MANANA LLC
FACILITY NUMBER: 374604401
VISIT DATE: 04/15/2024
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LIC 809 page 2

extinguishers (2) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA Mangina only interviewed Administrator as there were no clients in care. LPA interviews did not raise any licensing concerns. LPA reviewed staff or client records/files. Administrator’s Certification expires 7/18/24. Confidential records were stored in locked area. Licensee advised to have pharmacy update medication lists as medication orders change. Licensee also advised to document clients who manage their own P&I and conduct account reconciliation regularly for those whose money is managed by staff.

No deficiencies were observed or cited during today's annual inspection. See LIC9102 for technical violation given.


An exit interview was conducted with Administrator Cristina Hernandez to whom copies of this report and the Applicant/Licensee Rights (LIC9058 03/22) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619( 767-2351
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC809 (FAS) - (06/04)
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