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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602643
Report Date: 04/19/2022
Date Signed: 04/19/2022 05:11:18 PM


Document Has Been Signed on 04/19/2022 05:11 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:MEADOW CREEK VILLAFACILITY NUMBER:
374602643
ADMINISTRATOR:KARPAL, VINODFACILITY TYPE:
740
ADDRESS:11443 MEADOW CREEK ROADTELEPHONE:
(619) 277-8868
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 4DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Administrator, Vinod Karpal, TIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Vicky Williamson and Licensing Program Manager (LPM) Simon Jacob conducted an unannounced Required 1 -Year Visit. LPA and LPM were greeted and allowed entry by Caregiver, Monica Rizo, identified themselves, and discussed the purpose of the visit. During the visit, Administrator, Vinod Karpal arrived at the facility.

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; A sign-in policy enacted for all visitors; Face coverings worn by staff; Hand sanitizer/hand washing stations readily available; A designated visitation area; Emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment). Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808.

In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808). No deficiencies were observed during today's visit.

An exit interview was conducted with Administrator, Vinod Karpal, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via electronic mail. A read receipt email confirms these documents were received by the Administrator.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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