374602919-1-9-2024-08-AS-CLOZ-CZC66M-20240109193212

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602919
Report Date: 01/09/2024
Date Signed: 01/09/2024 07:32:52 PM

Document Has Been Signed on 01/09/2024 07:32 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	VILLA ALEGRE		FACILITY NUMBER:	374602919
ADMINISTRATOR:	LOCSIN, FREDERICK		FACILITY TYPE:	740
ADDRESS:	1938 HIDDEN SPRINGS DRIVE		TELEPHONE:	(619) 578-8788
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	6	CENSUS: 2	DATE:	01/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Donnah Locsin, Licensee and Frederick Docsin, Admiistrator		TIME COMPLETED:	07:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Administrator Frederick Locsin. LPA discussed the purpose of the visit with Administrator Locsin. Licensee Donnah Locsin later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents all of whom may be non-ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is 2 residents living at the facility. There were 2 resident(s) present at the facility site during the inspection. LPA, accompanied by Administrator Locsin, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Residents bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 69 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink was at 117 degrees F; sink in restroom #1 delivered hot water at 120 degrees F; sink in restroom #2 delivered hot water at 118.8 degrees F; and laundry room delivered hot water at 120 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked area. LPA inspected the medication cabinet and found that medications were properly labeled and stored. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VILLA ALEGRE	FACILITY NUMBER: 374602919
	VISIT DATE: 01/09/2024

NARRATIVE

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[CONTINUED FROM LIC 809]

The pool on the facility premise was gated and kept locked. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present (02). First aid kit(s) were complete and readily accessible.

During today’s visit there were 2 residents on the facility premise. LPA’s visit did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility.

There were no deficiencies observed or cited during today's annual inspection.

An exit interview was conducted with Licensee Locsin and Administrator Locsin to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.

LPA requested Licensee Locsin to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. The Residential Infection Control Plan LIC 9282 (6/23) was submitted to the San Diego Regional Office. Forms are available at www.ccld.ca.gov.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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