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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603448
Report Date: 03/06/2025
Date Signed: 03/06/2025 12:59:00 PM

Document Has Been Signed on 03/06/2025 12:59 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:GATE MANOR IIFACILITY NUMBER:
374603448
ADMINISTRATOR/
DIRECTOR:
MANIZA AMBALADAFACILITY TYPE:
740
ADDRESS:13106 GATE DRIVETELEPHONE:
(844) 320-1497
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Director, Maniza AmbaladaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA D. Roman was welcomed by, Director, Maniza Ambalada. LPA D. Roman provided a visual of CA State ID, identified himself as the LPA and discussed the purpose of the visit with Director, Maniza Ambalada. According to the facility’s license, the facility has a maximum capacity of six clients, of whom all may be non-ambulatory and one of which may be bedridden in bedroom 5. The facility is equipped with locked perimeters.

LPA D. Roman along with Director, Maniza Ambalada toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the adequate furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. Water temperature was measured at 120 degrees F. No pools or bodies of water on the premises. LPA inquired if firearms or ammunition are kept at the facility, to which the Director denied. Fire Alarms and Carbon Monoxide detectors were tested at 10:00am, emergency lighting, and facility telephone were all working. Fire extinguishers were present. First aid kits were complete and readily accessible.

Resident records reviewed had required documentation, Staff records reviewed CPR and First Aid certificates valid until 2027.

An exit interview was conducted with Director, Maniza Ambalada, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit. The signing of this report acknowledges their receipt of their rights and report.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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