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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600818
Report Date: 10/21/2021
Date Signed: 10/25/2021 04:47:38 PM

Document Has Been Signed on 10/25/2021 04:47 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MAR VISTA HOMEFACILITY NUMBER:
374600818
ADMINISTRATOR:LUZVIMINDA CABADINGFACILITY TYPE:
735
ADDRESS:275 MAR VISTATELEPHONE:
(760) 630-7221
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 6CENSUS: 6DATE:
10/21/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Rosa Gutierrez, House ManagerTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check for clients in care. LPA identified herself and was granted entry by Rosa Gutierrez, House Manager. LPA met with House Manager and disclosed the purpose of the visit.

As of October 12, 2021, residents were temporarily relocated due to facility repairs. During today's visit, LPA toured the rooms where the clients resided at the hotel and spoke with staff. Mitigation protocols were in place. All clients were doing well and no immediate health or safety concerns were observed. No deficiencies were cited during today’s visit.

An exit interview was conducted with Rosa Gutierrez, House Manager, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), was provided to Rosa Gutierrez, House Manager and Minda Cabading, Administrator via electronic mail. An electronic read receipt confirms the documents were received.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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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