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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603074
Report Date: 12/06/2023
Date Signed: 12/06/2023 11:10:44 AM

Document Has Been Signed on 12/06/2023 11:10 AM - 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:WILLIAMS QUESTFACILITY NUMBER:
374603074
ADMINISTRATOR:BAGALSO, LESLIEANNFACILITY TYPE:
775
ADDRESS:640 CIVIC CTR DR, STE 101-106TELEPHONE:
(760) 806-7500
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 90CENSUS: 50DATE:
12/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:ADMINISTRATOR, LESLIEANN BAGALSOTIME COMPLETED:
11:13 AM
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On December 06, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with the Administrator, Kendra Rivers, and Administrator/Licensee, Leslieann Bagalso, introduced herself, and stated the purpose of the visit.

LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story industrial type building located at 640 Civic Center Drive 101-106 Vista, CA 92084. The facility phone number is (760)806-7500, and is operable.
Physical Plant: The physical plant, is in good condition, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of this visit. The day program activity rooms have the required furniture; such as tables, chairs, storage space, and sufficient lighting. The building temperature throughout was within regulations, and set at 70. All activity rooms were equipped with the required items. The Administrator stated the hot water is tested daily and it is logged. The restrooms were equipped with liquid soap and paper towels. LPA Mixson toured the kitchen area, and it was clean and free of odors. The facility had activity schedules posted and available for review. The day program has emergency food and water supply. LPA Mixson inspected the common areas. The smoke detectors are hard wired and were tested recently by the Fire Department of Vista. The fire extinguishers were in the green and the program recently had a fire inspection in 2023. Carbon monoxide alarms, along with smoke detectors were observed. Medications: were locked and inaccessible to the residents in care. The Group Homes send the resident's monthly supply of mediations, and the Administrator sends an email, text, or phone call to re-supply the medications when they run low. The day program had a designated area for residents and staff files, and it was locked and inaccessible to the residents. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed monthly activity calendars. LPA Mixson reviewed six staff files, six resident files, and conducted five staff interviews and five resident interviews. There were no regulation violations observed during todays visit. An exit interview was conducted and a copy of this report was provided to Administrator, Kendra Rivers.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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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