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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008431
Report Date: 05/28/2024
Date Signed: 05/28/2024 03:26:57 PM

Document Has Been Signed on 05/28/2024 03:26 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VILLA ESPERANZA IIFACILITY NUMBER:
372008431
ADMINISTRATOR/
DIRECTOR:		RADJENOVIC, MIRJANAFACILITY TYPE:
735
ADDRESS:821 EAGLES NEST GLENTELEPHONE:
(760) 741-5424
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 4DATE:
05/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Mirjana Radjenovic, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual required visit on 5/28/2024 at 01:40 p.m. LPA was granted entry and met with Licensee, Mirjana Radjenovic who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (3) clients present.

The facility is a two story home with (6) bedrooms and (5) bathrooms with attached garage. No pools or firearms are being kept at the facility. The facility is licensed for the first floor only for clients with (3) bedrooms and (2) bathrooms. The clients served are adults between the ages of 18-59. The facility is not vendorized with a regional center. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements.



Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients in locked kitchen drawer. The smoke detector and carbon monoxide were operational, and the hot water temperature 111F.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLA ESPERANZA II
FACILITY NUMBER: 372008431
VISIT DATE: 05/28/2024
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Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator has submitted their administrator's certificate and is pending renewal.

Record Review and Resident/Staff Files: LPA reviewed (4) staff files and training. All staff have criminal clearance as well as current CPR/First Aid training. All client files were reviewed, and LPA found they possessed all the required paperwork.

Health Related Services/ Incidental Medical Services: All client medication was locked in a closet. LPA reviewed client medications and reviewed the facility's system for reviewing medication. All required labeling and medication was found to be in place.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan, this will need to be updated to a new LIC610D. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit.

No deficiencies were observed during today's inspection.

An exit interview was conducted where a copy of this report along LIC 811 were provided to the Licensee, Mirjana Radjenovic.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC809 (FAS) - (06/04)
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