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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603286
Report Date: 10/14/2020
Date Signed: 10/14/2020 10:51:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VISTA CARE IN CARLSBADFACILITY NUMBER:
374603286
ADMINISTRATOR:ANA RADOVANOVICFACILITY TYPE:
740
ADDRESS:1275 CYNTHIA LANETELEPHONE:
(760) 994-0184
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:0CENSUS: 4DATE:
10/14/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Ana RadovanovicTIME COMPLETED:
09:10 AM
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Licensing Program Analyst (LPA), Alexandre Vo, conducted virtual visit regarding facility closure due to a Change of Ownership. Virtual visits are being conducted due to COVID-19 restrictions and was completed via FaceTime. LPA contacted Administrator, Ana Radovanovic. LPA identified himself and stated the purpose of the call.

During today's call, LPA briefly toured the facility and verified the residents' placement. No residents were relocated and they were visually verified on the call. LPA requested the original license from the Administrator who stated that it will be dropped off at the office.

An exit interview was conducted, and a copy of this report and Licensee's Rights (9058 01/16) were provided to the Administrator via electronic mail. An e-mail receipt confirms the acceptance of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020
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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