<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604447
Report Date: 11/16/2021
Date Signed: 11/16/2021 03:51:29 PM

Document Has Been Signed on 11/16/2021 03:51 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CASA DE ORO RESIDENTIAL CAREFACILITY NUMBER:
374604447
ADMINISTRATOR:BAILEY, CHARITYFACILITY TYPE:
735
ADDRESS:3602 S CORDOBA AVENUETELEPHONE:
(619) 303-3717
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 26CENSUS: 25DATE:
11/16/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Charity Bailey, AdministratorTIME COMPLETED:
10:54 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Tiffany Holmes conducted an unannounced case management visit. LPA Holmes introduced herself and was allowed entry into the facility and explained the purpose of the visit to Administrator Charity Bailey.

Today’s visit was regarding client health checks. During today’s visit LPA interviewed staff and reviewed facility records and toured the facility.

An incident report received in the office on 11/11/2021 was reviewed with Administrator Charity. Client was AWOL and was reported missing but staff found out C1 was arrested and released for being under the influence. C1 was gone for a week and Harbor Police found C1 and brought C1 back to the facility. Facility staff gave C1 their medications and the next day C1 and another client were having an argument. C1 had 3 pipes and methamphetamines in it. 911 was called due to C1 getting verbally aggressive and getting into the staffs faces. The sheriffs did not take C1 this time but advised C1 if they were called again they would arrest C1. C1 AWOL'd again on 11/14/2021 after being gone for 24 hrs.

Based on today's inspection, no deficiencies were observed.

An exit interview was conducted with Charity Bailey, Administrator. A copy of this report, and the Licensee/Appeal Rights (9058 01/16) were provided via e-mail. An electronic read receipt verifies receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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 1