<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004440
Report Date: 08/24/2022
Date Signed: 08/24/2022 05:05:47 PM


Document Has Been Signed on 08/24/2022 05:05 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:VILLA AT PLEASANT HILLS, THEFACILITY NUMBER:
306004440
ADMINISTRATOR:CASEY VILLAVERDEFACILITY TYPE:
740
ADDRESS:938 JOYCE DRIVETELEPHONE:
(714) 582-2345
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:6CENSUS: 0DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Casey Villaverde TIME COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with Administrator Casey Villaverde and stated the purpose of this visit.

The facility is a single-level structure licensed for six non-ambulatory with a hospice waiver for two. This facility offers Residential Care for the Elderly/Hospice.

At about 3:55 pm, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed no residents in care and no staff members on duty. LPA toured the interior and exterior portions of the facility. LPA was previously informed that the facility has no residents or staff. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 115.1 degrees Fahrenheit. For the exterior portion, furniture was in good repair; and grounds were free of tripping hazards. Backyard contained 3 sheds for storage. Facility offers a 2-car garage which is used for storage and office space. Administrator was made aware late annual fee. Administrator paid annual fees online and received a confirmation number. Administrator was also informed to contact the Department before taking in any residents.

LPA Tapia reviewed the COVID 19 mitigation plan and Emergency Disaster plan of the facility.



For this visit, no deficiency was noted in areas observed. No citation was issued. No advisory was issued today.

LPA Tapia conducted an exit interview with Administrator Casey Villaverde and copy of this report was explained and left at the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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 1