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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603462
Report Date: 08/16/2021
Date Signed: 08/16/2021 05:59:28 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: 20DATE:
08/16/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Dolores McGonigal, Resident Services ManagerTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct an unannounced case management visit. Facility is currently under a non-compliance plan that includes increased monitoring and visits due to the facility’s probationary license status. LPA was granted entry into the facility and met with Dolores McGonigal, Resident Services Manager, with whom she discussed the purpose of the visit.

During today's visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents, and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy and signs in the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer readily available; available visitation areas; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of cleaning products and PPE.

No deficiencies were cited during today’s visit. An exit interview was conducted with Dolores McGonigal, Resident Services Manager, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) were provided to the Resident Services Manager via email. An electronic receipt of confirmation was 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: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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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