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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603323
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:34:18 PM

Document Has Been Signed on 08/08/2024 04:34 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BARON'S PRESIDIO UNIVERSITY CITYFACILITY NUMBER:
374603323
ADMINISTRATOR/
DIRECTOR:		NARMINA MAMEDOVAFACILITY TYPE:
740
ADDRESS:6860 CONDON DRIVETELEPHONE:
(858) 558-4772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 5DATE:
08/08/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Caregiver Ester VillarTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Annual Continuation Inspection. The LPA identified himself and disclosed the purpose of the visit to Caregiver Ester Villar. The facility was licensed for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden. The facility also had a hospice care waiver approved for two (2) residents.

The LPA reviewed the facility Infection Control Plan, Emergency Disaster Plan, and staff and resident records. There were not immediate concerns and the LPA provided technical advise. The facility was clean, sanitary, and in good condition. No deficiencies were observed, nor cited on today's date.

An exit interview was conducted with Caregiver Ester Villar, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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