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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603173
Report Date: 11/16/2023
Date Signed: 11/16/2023 10:47:30 AM


Document Has Been Signed on 11/16/2023 10:47 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:PARK VIEW VILLAFACILITY NUMBER:
374603173
ADMINISTRATOR:MICHAEL MORANFACILITY TYPE:
740
ADDRESS:351 PARK RANCH PLACETELEPHONE:
(760) 737-7275
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
11/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:ADMINISTRATOR, MICHAEL MORANTIME COMPLETED:
10:52 AM
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On November 16, 2023, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct an annual licensing inspection, and met with the Licensee, Michael Moran. The LPA introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility along with the Facility Manager, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is licensed to serve six senior residents and are currently operating at full capacity.
Physical Plant: The facility is a single story home located at 351 Park Ranch Place Escondido, Ca. 92025, and the facility phone number is, (760) 737-7275, and it is operable. The LPA observed the resident's bedrooms, and the bedrooms were equipped with required furniture as per Title 22. The LPA inspected the facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers, and a first aid kit with manual. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated space for the resident and staff files. Medications: The medications were, locked, and inaccessible to the residents. The overall facility is clean, and the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there were a variety of food types. Dishes and utensils are in sufficient supply and stored properly. Care & Supervision: Facility has sufficient staff, two caregivers and the Licensee at the time of this visit, and the staff were attentive and engaging the resident with the morning meal. Records Review: The LPA reviewed six resident files, three staff files, and reviewed previous CCL forms. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit. An exit interview was conducted and a copy of this report was given to the Facility Manager, Hernand Ilagan.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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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