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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603125
Report Date: 02/22/2023
Date Signed: 02/25/2023 02:15:45 AM

Document Has Been Signed on 02/25/2023 02:15 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:RANCHO SANTA FE VILLAFACILITY NUMBER:
374603125
ADMINISTRATOR:BAHA, RAY CYRUSFACILITY TYPE:
740
ADDRESS:8292 RUN OF THE KNOLLSTELEPHONE:
(858) 361-3322
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 6CENSUS: 5DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Administrator, Cyrus Ray BahaTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to follow-up and provide guidance on observations made during a complaint visit. LPA was granted entry into the facility by Caregiver, Angelita Hernandez. LPA met with Administrator, Baha,to whom LPA disclosed the purpose of the visit.

During a complaint visit, the LPA provided guidance to facility staff regarding Postural Supports and discussed and provided copies of Title 22, Chapter 8, 87608 Postural Supports regulations.

An exit interview was conducted with Administrator, Baha, to whom a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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