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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604447
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:38:52 PM

Document Has Been Signed on 08/28/2024 04:38 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 DE ORO RESIDENTIAL CAREFACILITY NUMBER:
374604447
ADMINISTRATOR/
DIRECTOR:		BAILEY, CHARITYFACILITY TYPE:
735
ADDRESS:3602 S CORDOBA AVENUETELEPHONE:
(619) 303-3717
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 26CENSUS: 24DATE:
08/28/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Charity Bailey, AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Tiffany Holmes conducted the case management visit to clear the plan of correction for the deficiency from 08/27/2024 and LPA Holmes met with Charity Bailey, Administrator

During the visit the LPA observed the and measured the hot water in bathrooms that were high. LPA was able to clear the Plan of Correction (POC) cited on 08/27/24. The hot water ranged from 112.8- 111.8 degrees on todays date.

A POC letter was provided to Charity Bailey, Administrator confirming the POC was completed.

An exit interview was conducted with Charity Bailey, Administrator. A copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) were provided to the facility at the conclusion of the visit. The signature below confirms receipt of these documents
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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