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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601438
Report Date: 08/31/2022
Date Signed: 08/31/2022 01:51:21 PM

Document Has Been Signed on 08/31/2022 01:51 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:DEL CERRO MANOR IIFACILITY NUMBER:
374601438
ADMINISTRATOR:BARTH, BENJAMINFACILITY TYPE:
740
ADDRESS:7232 GLENFLORA AVENUETELEPHONE:
(619) 741-7667
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 6CENSUS: 6DATE:
08/31/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Caregiver Sayra OlveraTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Iby Strong conducted a case management visit to deliver an amended report. LPA met with Caregiver Sayra Olvera, informed her of the purpose of the visit, and was granted entry.

Today's visit is to deliver an amended report from the Required-1 Year Visit conducted on 08/10/2022. All staff present have a current criminal record clearance.

The amended report was reviewed with Caregiver Sayra Olvera, and signatures were obtained. An exit interview was conducted, Appeal Rights (LIC 9058 01/16) along with a copy of this report was provided to Caregiver Sayra Olvera.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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