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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603349
Report Date: 09/21/2022
Date Signed: 09/21/2022 10:39:23 AM


Document Has Been Signed on 09/21/2022 10:39 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,
, 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:
09/21/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Sylvia Mendoza, CaregiverTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check in response to the increased inspections for the Compliance Plan generated September 2, 2021. LPA identified herself and was granted entry by Sylvia Mendoza, caregiver. LPA met with caregiver Mendoza and disclosed the purpose of the visit.

During today's visit LPA briefly spoke with a resident and staff. LPA spoke with Licensee Dobrila Milosavljevic via telephone for updates. No immediate health or safety concerns were observed.

An exit interview was conducted with Sylvia Mendoza, caregiver and a copy of the report along with Licensee/Appeal Rights (LIC9058 03/22) was provided to caregiver Mendoza at the conclusion of the visit. The signature below serves as confirmation the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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