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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602869
Report Date: 01/11/2022
Date Signed: 01/11/2022 06:17:51 PM

Document Has Been Signed on 01/11/2022 06:17 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:CEDARS @ PARADISE VILLAGEFACILITY NUMBER:
374602869
ADMINISTRATOR:NITHI NARASAPPAFACILITY TYPE:
740
ADDRESS:2740 E 4TH STREETTELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 150CENSUS: 96DATE:
01/11/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Administrator, Nithi NarasappaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno, and County of San Diego Senior Public Health Nurses, Robert Montillano and Jennifer West, conducted an in-person visit. All staff present at the facility had a current criminal record clearance.

LPA and Nurse Montillano and West identified themselves and discussed the purpose of the visit with Administrator, Nithi Narasappa.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection and screening protocols. During today's visit, the team interviewed the Administrator and provided consultation and conducted a walk-though of the facility. A debriefing was conducted with the Administrator at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Administrator, Narasappa, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2022
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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