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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604447
Report Date: 12/22/2021
Date Signed: 12/22/2021 03:21:51 PM

Document Has Been Signed on 12/22/2021 03:21 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: 23DATE:
12/22/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Charmaine Mister, Caregiver
& Charity Bailey, Administrator		TIME COMPLETED:
12:01 PM
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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.
Based on today's inspection, LPA counted P&I monies for two clients. The monies were accurate and matched the balance forms.

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: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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