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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604447
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:03:35 AM

Document Has Been Signed on 01/10/2025 11:03 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
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: 25DATE:
01/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Charity Bailey, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analysts (LPAs) Tiffany Holmes conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Charity Bailey, Administrator.

Today's visit was in response to an LIC 624 Incident Report, which licensee self submitted to the CCLD San Diego Regional Office (received on 01/09/2025), involving Client #1 (C1). [See LIC 811 Confidential Names List for a description of C1].


During today’s visit, LPA performed a brief facility tour, collected copies of pertinent records, and interviewed relevant staff.

According to the LIC 624 and corroborated by staff interviews: Sometime between 840 pm and 845 pm,
(C1) reported to staff that they took a white substance and was not feeling well. C1 complained of their vision being blurry and their words were unclear/mumbled and then C1 lost consciousness and staff administered Narcan and called 911 around 8:45pm. Client was transported to the hospital where they were diagnosed with an “accidental opioid overdose.” Interviews revealed that C1 came back to the facility before 1am.

Records review, confirmed by administrator interview, showed: Staff acted appropriately and promptly in getting C1 the help they needed.

No deficiencies were observed or cited during todays visit.

An exit interview was conducted with Charity Bailey, to whom a copy of this report, the Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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