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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603349
Report Date: 04/25/2022
Date Signed: 04/25/2022 05:12:24 PM


Document Has Been Signed on 04/25/2022 05:12 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:
04/25/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Dobrila Milosavljevic, Licensee and Miljana VasicTIME COMPLETED:
05:15 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 clients in care. LPA identified herself and was granted entry by Miljana Vasic, Caregiver. LPA met with caregiver Vasic and disclosed the purpose of the visit. Licensee, Dobrila Milosavljevic, later arrived and spoke with LPA.

During today's visit, LPA toured the facility, and spoke with staff and clients. No immediate health or safety concerns were observed. No deficiencies were cited during today's visit.

An exit interview was conducted with Miljana Vasic, caregiver and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Dobrila Milosavljevic, Licensee via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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