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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604299
Report Date: 03/04/2025
Date Signed: 03/04/2025 04:16:20 PM

Document Has Been Signed on 03/04/2025 04:16 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:PARKSIDE VILLA ASSISTED LIVINGFACILITY NUMBER:
134604299
ADMINISTRATOR/
DIRECTOR:
SIKLALIC GARCIAFACILITY TYPE:
740
ADDRESS:1685 CYPRESS DRTELEPHONE:
(442) 271-4109
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY: 18TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
03/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Evelyn Ramirez, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Angelica Boyles made an unannounced visit to conduct the required One-Year Inspection. LPA was granted entry into the facility by Evelyn Ramirez, House Manager, after identifying herself and stating the purpose of the inspection. The facility serves 18 elderly residents, age 60 and above, all whom may be non-ambulatory.

During today’s visit, LPA performed a welfare check on all residents in care, interviewed facility staff, and reviewed records of residents and staff. LPA, accompanied by House Manager, toured the interior and exterior of the facility, and inspected all common areas and client bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to clients. The facility had a pool on the premises which had a locked fence in good repair and is designed to surround the pool and may not be removed. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detector, night lights, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility.

LPA reviewed multiple staff records/files and interviewed staff and residents. The interviews did not raise any immediate health and safety concerns. The reviewed files contained all required documents. LPA also conducted a review of In-service training procedures.

[Continued on 809-C]
Simon JacobTELEPHONE: (619) 767-2306
Angelica BoylesTELEPHONE: 619-767-2301
DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: PARKSIDE VILLA ASSISTED LIVING
FACILITY NUMBER: 134604299
VISIT DATE: 03/04/2025
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[Continued from 809]

According to House Manager food supply is cooked and delivered from another facility for breakfast, lunch, and dinner. LPA observed an adequate two-day supply of perishable and seven-day supply of nonperishable food items.

Based on today’s inspection, no deficiencies were observed or cited. A final exit interview and a copy of this report were provided to Evelyn Ramirez, House Manager, whose signature on this form acknowledges receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Angelica BoylesTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC809 (FAS) - (06/04)
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