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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600818
Report Date: 07/29/2023
Date Signed: 07/30/2023 11:10:11 PM

Document Has Been Signed on 07/30/2023 11:10 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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: 5DATE:
07/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Zoe Wilson, AdministratorTIME COMPLETED:
06:55 PM
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA met with Zoe Wilson, Administrator and Administrator Cynthia Meyer and explained the nature of the visit. The facility was inspected inside and out. At the time of this visit there were five(5) clients and two(2) staff present. Staff and client interviews were conducted. The facility is approved for Developmentally Disabled Adults ages 18-59 years, all of who may be non-ambulatory.

The facility is a one story home with five(5) bedrooms and three(3) bathrooms. LPA observed that the outdoor passageways are free from obstruction. Hazardous materials are inaccessible to clients. Indoor temperature was comfortable, lighting was adequate in all rooms, bathrooms are in good working order, and the facility has sufficient personal hygiene items on hand to meet the client’s needs. Bedrooms were observed to be neat and clean with appropriate furnishings and accommodations. The last fire drill was conducted on 7/19/2023. Smoke and carbon monoxide alarms were tested and found operational. The fire extinguishers are fully charged.

Food is being prepared and stored properly. There is two(2) days of perishable and a seven(7) days of non-perishable food per regulation. Hot water temperature was measured at 119.4 degrees Fahrenheit and the indoor temperature is 74 degrees.

The facility has developed and implemented a plan to ensure that the clients receive assistance in meeting their medical and dental needs, the client’s IPP Plans are current and maintained in the client’s file.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2023
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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MAR VISTA HOME
FACILITY NUMBER: 374600818
VISIT DATE: 07/29/2023
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 Personal rights and admission agreement are in file and up to date.
P&I monies are kept in a locked safe in the Administrator's office and are maintained separately from facility funds. All staff have criminal record clearance and current first aid certificates. Medications are stored in a locked cabinet in the kitchen and appear to be administered according to physician's instructions.

During the inspection, no deficiencies were observed.
An exit interview was conducted and a copy of this report and LIC811 was provided to Administrator Zoe Wilson.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023
LIC809 (FAS) - (06/04)
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