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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603462
Report Date: 12/10/2021
Date Signed: 12/10/2021 03:31:14 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: 22DATE:
12/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Manager Dolor McgonigalTIME COMPLETED:
12:45 PM
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Licensing Program Manager (LPM), Simon Jacob and Licensing Program Analyst (LPA), Sabel Martinez conducted an unannounced case management visit to follow up on incident reports received on November 29, 2021 regarding medication issues.

LPM and LPA were greeted by Manager Dolor Mcgonigal, introduced themselves, and stated the purpose of the visit. During today's visit, LPM and LPA conducted an interview with Ms. Mcgonigal, reviewed facility protocols regarding medication dispersal/administration, reviewed staff records, and conducted a tour of the facility. No deficiencies were cited during today's visit.

An exit interview was conducted with Manager Dolor Mcgonigal. A copy of this report, along with the Licensee Rights (9058 01/16) were emailed to Administrator Orlando Dy via electronic mail. An email read receipt confirms these documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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