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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600818
Report Date: 12/15/2021
Date Signed: 12/16/2021 09:23:45 AM

Document Has Been Signed on 12/16/2021 09:23 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, 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:
12/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Minda Cabading, Administrator, and Rosa Gutierrez, Facility ManagerTIME COMPLETED:
03:30 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, Facility Manager.

During the visit, LPA toured the facility, took photos of the repairs completed throughout the facility, and inspected the food supply. LPA also discussed the return of clients' belongings to the facility.

Based on LPA's observations and in speaking with the Administrator and Facility Manager, there is a sufficient supply of food for meals for clients in care. During today's visit, no immediate health or safety concerns were observed. No deficiencies were cited.

An exit interview was conducted with the Facility Manager and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Administrator Cabading via email. An electronic email receipt confirms the documents were received.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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