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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881533
Report Date: 12/31/2024
Date Signed: 12/31/2024 10:58:25 AM

Document Has Been Signed on 12/31/2024 10:58 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALTA VISTA MANORFACILITY NUMBER:
371881533
ADMINISTRATOR/
DIRECTOR:		WILSON, JOHNFACILITY TYPE:
740
ADDRESS:625 MARAZON LANETELEPHONE:
(760) 298-0506
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 15CENSUS: 10DATE:
12/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:ADMINISTRATOR, ANNA WILSONTIME VISIT/
INSPECTION COMPLETED:
11:14 AM
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On December 31, 2024, Licensing Program Analysts (LPA), Venus Mixson arrived unannounced to conduct a Case Management Health and Safety visit, and met with Administrator, Anna Wilson.

During the visit LPA toured the facility along with the Administrator, Anna Wilson, and made observations. There were no Health and/or Safety issues observed at this time.

LPA conducted a review of the records to include the Emergency Approval to Operate (EAO), with a new date of renewal up until the 13, of January 2025.

The administrator has followed up scheduled with the local fire department, but called during today’s visit, to determine there are no current issues or concerns with the present system. The Licensee just wanted to upgrade the system and was not aware this would be such a lengthy process.

LPA observed facility utilities to be operating at the time of this visit. LPA assessed the available food supply and observed there was a variety of food types. Additionally, the supply exceeds the required two-day supply of perishable food items, and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care, with an automated delivery rotation by Quality Care Pharmacy, (QCP).

Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were observed or cited during today's visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Anna Wilson.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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