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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601357
Report Date: 07/06/2022
Date Signed: 07/06/2022 12:23:59 PM


Document Has Been Signed on 07/06/2022 12:23 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



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: 0DATE:
07/06/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sasa Djordjevic, AdministratorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility and conducted a case management visit. LPA met with Administrator Sasa Djordjevic and explained the purpose of the visit.

During today's visit, LPA was informed that the facility was closed on June 20, 2022. LPA toured the facility and verified that no residents were present. LPA observed the facility to be nearly void of all furniture and was in the beginning stages of being re-painted.
An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/06/2022
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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