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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604401
Report Date: 05/31/2022
Date Signed: 05/31/2022 11:51:19 AM

Document Has Been Signed on 05/31/2022 11:51 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
CCLD Regional Office, 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: 2DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Cristina HernandezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Required 1 - Year Visit and Post-licensing inspection. LPA Martinez was greeted by Administrator, Cristina Hernandez, identified himself, and discussed the purpose of the visit. The facility is approved for four (4) ambulatory residents only.

During today's inspection, the LPA observed the following: No pools or bodies of water were observed. Exterior and interior passageways were free from obstructions. Toxins, cleaning supplies, and chemicals were locked and inaccessible to residents at the time of the visit. Each resident had clean and sufficient bed linens, towels, and washcloths. All of the residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and operational. The facility was stocked with a 2-day supply of perishable and a 7-day supply of nonperishable food items. The food was observed to be properly labeled and stored. Medications were stored in a locked cabinet and were labeled and maintained in compliance with label instructions.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808). The LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; and emergency agencies’ contact information posted in a location visible to staff and resident. Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit.

An exit interview was conducted with Administrator, Cristina Hernandez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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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