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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603074
Report Date: 11/08/2024
Date Signed: 11/08/2024 11:45:50 AM

Document Has Been Signed on 11/08/2024 11:45 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/
DIRECTOR:		BAGALSO, LESLIEANNFACILITY TYPE:
775
ADDRESS:640 CIVIC CTR DR, STE 101-106TELEPHONE:
(760) 806-7500
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 90CENSUS: 50DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:59 AM
MET WITH:ADMINISTRATOR, KINDRA RIVERSTIME VISIT/
INSPECTION COMPLETED:
11:53 AM
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On November 08, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the Day Program unannounced to conduct the required annual inspection. LPA Mixson met with the Administrator, Kendra Rivers, and Administrator/Licensee, Leslieann Bagalso, identified herself, and stated the purpose of the visit. The facility file review was conducted in the Regional Office and additional records were requested and reviewed on cite.

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. The 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.

kitchen area, was observed and it was clean and free of odors, and pest. The facility had activity schedules posted and available for review. The day program has emergency food and water supply, that is rotated every two weeks. The water is delivered every two weeks, on Thursdays. LPA Mixson inspected the common areas. The smoke detectors are hard wired and were tested recently by the Johnson Controls is the company that came out to services Fire alarm system.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 QUEST
FACILITY NUMBER: 374603074
VISIT DATE: 11/08/2024
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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 April of 2024, Cintas is the company that came out and tested and replaced equipment. 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. Additionally, the administrator will speak personally to the staff or family when the residents are picked up.
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 five staff files, five resident files, and conducted two staff interviews and two resident interviews. There were no regulation violations observed or cited during today’s visit.

An exit interview was conducted, and a copy of this report was discussed and given to Administrator, Kendra Rivers.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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