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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603125
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:16:54 PM


Document Has Been Signed on 04/30/2024 12:16 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:RANCHO SANTA FE VILLAFACILITY NUMBER:
374603125
ADMINISTRATOR:BAHA, RAY CYRUSFACILITY TYPE:
740
ADDRESS:8292 RUN OF THE KNOLLSTELEPHONE:
(858) 361-3322
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:6CENSUS: 2DATE:
04/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Caregiver Weny LabuguinTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA identified himself to and disclosed the purpose of the visit to Caregiver Weny Labuguin. The facility was licensed for a capacity of six (6), of which four (4) could be bedridden in rooms 1,4,5, and 6. At the time of the visit, the census was two (2).


The LPA, accompanied by caregiver, 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. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, and stored in locked areas.



No pools, or bodies of water were observed on the premises. Per staff, no firearms or ammunition were kept at the facility. A carbon monoxide detector, facility telephone, and fire extinguisher were present. Required licensing postings were observed in a visible area of the facility.

The LPA interviewed staff and reviewed multiple staff and resident records/files. The files which LPA reviewed contained required documents. No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Caregiver Labuguin, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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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