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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601357
Report Date: 06/24/2021
Date Signed: 06/24/2021 07:36:22 PM

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:VISTA ROYAL ASSISTED LIVINGFACILITY NUMBER:
374601357
ADMINISTRATOR:DJORDJEVIC, SASAFACILITY TYPE:
740
ADDRESS:2336 VISTA ROYALTELEPHONE:
(760) 598-1435
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:6CENSUS: 4DATE:
06/24/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sasa Djordjevic, LiceneseTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Carmen Lopez, made an announced visit to the facility to deliver civil penalties from the Annual Inspection conducted on June 23, 2021, and PPE. LPA identified herself and was granted entry by Eufrosina, Djukic. LPA met with Sasa Djordjevic, Licensee and discussed the purpose of today’s visit.

Based on today’s inspection, no additional deficiencies were observed at this time. This report was discussed with Sasa Djordjevic, Licensee. A copy along with Licensee Rights (01/2016) was emailed to Sasa Djordjevic, Licensee at the conclusion of the visit. An electronic response confirms the receipt of these documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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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