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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604401
Report Date: 09/20/2022
Date Signed: 09/20/2022 09:20:22 AM

Document Has Been Signed on 09/20/2022 09:20 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: 3DATE:
09/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Licensee, Christina HernandezTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an on-site Case Management visit at the facility. LPA Hamilton was greeted at the front door by Licensee, Christina Hernandez and granted entry after identifying herself. LPA Hamilton discussed the purpose of the visit.

The purpose of the visit was to discuss an incident reported on an unrelated on-site visit at the facility. The Licensee reported client 1 (C1 – See confidential names list LIC 811) went AWOL on September 13, 2022 and returned. During today’s visit, LPA Hamilton interviewed staff, requested copies of client records and briefly toured the facility. No deficiencies were cited at this time.

An exit interview was conducted with Licensee, Christina Hernandez and a copy of this report, LIC 811 along with Licensee/Appeal Rights (LIC9058 01/16) was provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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