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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603462
Report Date: 05/24/2021
Date Signed: 05/24/2021 02:36:34 PM

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:VILLA MONTICELLO ASSISTED LIVINGFACILITY NUMBER:
374603462
ADMINISTRATOR:ORLANDO DYFACILITY TYPE:
740
ADDRESS:25695 N. CENTRE CITY PARKWAYTELEPHONE:
(760) 738-1557
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:29CENSUS: 14DATE:
05/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 PM
MET WITH:Dolores McGonigal, Resident Services ManagerTIME COMPLETED:
11:05 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted a Case Management visit to observe the physical plant for compliance with California Code of Regulations, Title 22, Division 6. The LPA was granted entry and met with Dolores McGonigal, Resident Services Manager, with whom she discussed the purpose of the visit..

An application to change the ambulatory status of the facility was received by the San Diego Regional Office on 05/01/2020. A Fire Safety Inspection Request for 22 non-ambulatory and 7 bedridden residents was approved by the local fire authority on 06/18/2020. During today’s visit, LPA and Resident Services Manager toured the facility. LPA observed that bedrooms # 1, 3, 4, 6, 8, and 9 are equipped with fire doors and direct exits to accommodate bedridden residents. Bedroom # 3 is designed to accommodate two residents. Following today’s inspection, the request for bedridden status will be recommended for approval, and a new license will be issued to the licensee upon final review and approval.

An exit interview was conducted with Dolores McGonigal, Resident Services Manager, and a copy of this report and licensee appeal rights will be provided via electronic mail. Confirmation of receipt is requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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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