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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603448
Report Date: 10/02/2023
Date Signed: 10/02/2023 02:19:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/22/2023 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20230922145257
FACILITY NAME:GATE MANOR IIFACILITY NUMBER:
374603448
ADMINISTRATOR:MANIZA AMBALADAFACILITY TYPE:
740
ADDRESS:13106 GATE DRIVETELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator Maniza AmbaladaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility is in disrepair
Staff did not keep the facility free from cockroaches
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Rodgers and Licensig Program Manders (LPM) Denise Powell made an unannounced visit to the facility to conduct a Complaint Visit . LPA Rodgers and LPM Powell were met by Maniza Ambalada, Administrator, and were granted entry into facility. LPA met with Ms. Ambalanda and discussed the purpose of the visit.

At 11:05 am LPA and LPM toured facility and interviewed staff. LPA inspected the kitchen cabinets and drawers including food pantry areas. LPA did not observe any dead or alive cockroaches. Record review confirmed facility has ongoing pest control services and has added interior roach control. Facility interior appeared clean and in overall good condition. LPA and LPM inspected water leak area located inside the staff office. Repairs were made timely and no evidence of current leak, dry rot, or mildew was observed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20230922145257
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: GATE MANOR II
FACILITY NUMBER: 374603448
VISIT DATE: 10/02/2023
NARRATIVE
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continued 9099

Based on observations and record reviews there is insufficient evidence to support the allegations.

The allegations are determined as unsubstantiated meaning they could have happened or be true, there is not a preponderance of evidence to meet the standard. An exit interview was conducted with Maniza Ambalada, Administrator, and a copy of this report along with the licensee rights was provided.

Administrator signature confirms receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2