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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604267
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:12:19 PM

Document Has Been Signed on 11/15/2024 01:12 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:CLOISTERS OF THE VALLEY, LLCFACILITY NUMBER:
374604267
ADMINISTRATOR/
DIRECTOR:		DISHA FRANCES-HALLFACILITY TYPE:
740
ADDRESS:4171 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 283-2226
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 70CENSUS: 62DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Executive Director Tia Suuronen-GoodwinTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Manager (LPM) Lizzette Tellez and Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Case Management visit. LPM and LPA met and discussed the purpose of the visit with Executive Director, Tia Suuronen-Goodwin.

On November 6, 2024, the Department issued an Order of Immediate Exclusion for S1. [See LIC811 Confidential Names List for a description of person identifiers used in this report.] Per facility staff, the individual was a former employee who was terminated on or about 7/14/2020. During today’s visit, LPM and LPA briefly toured the facility and performed a welfare check on residents in care. LPA verified that S1 was not present or presently employed at the facility.

This report was discussed with Ms. Suuronen-Goodwin. A copy of this report, along with Licensee/Appeal Rights, was provided to her at the conclusion of the visit. Her signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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