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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603349
Report Date: 06/02/2022
Date Signed: 06/02/2022 12:59:31 PM


Document Has Been Signed on 06/02/2022 12:59 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
CCLD Regional Office,
, CA



FACILITY NAME:VISTA VILLAGE CAREFACILITY NUMBER:
374603349
ADMINISTRATOR:SMILJA MILOSAVLJEVICFACILITY TYPE:
740
ADDRESS:222 WASHINGTON STREETTELEPHONE:
(760) 295-7258
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 10DATE:
06/02/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Dobrila Milosavljevic, LicenseeTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check for residents in care. LPA identified herself and was granted entry by Blanca Santiago, Caregiver. LPA met with caregiver Santiago and disclosed the purpose of the visit. Licensee, Dobrila Milosavljevic, later arrived and spoke with LPA.

During today's visit, LPA briefly spoke with staff and residents. No immediate health or safety concerns were observed. No deficiencies were cited during today's visit. LPA discussed Title 22, Section 87224 Eviction Procedures and provided a copy of the section to Licensee Milosavljevic.

An exit interview was conducted with Licensee Milosavljevic and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Licensee Milosavljevic at the conclusion of the visit. The signature below confirms the receipt that the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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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