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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603485
Report Date: 03/11/2022
Date Signed: 03/14/2022 08:18:51 AM

Document Has Been Signed on 03/14/2022 08:18 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VILLA SAN FRANCISCOFACILITY NUMBER:
374603485
ADMINISTRATOR:ELIZABETH ENRIQUEZFACILITY TYPE:
735
ADDRESS:734 RIVERLAWN AVETELEPHONE:
(619) 500-5356
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 4CENSUS: 3DATE:
03/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Administrator Elizabeth EnriquezTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management visit. LPA was greeted and allowed entry by Caregiver Adal Appel, and we discussed the purpose of the visit. Administrator Elizabeth Enriquez arrived during the visit.

Today's visit is in response to the reported death of Client 1 (C1 - See LIC811 Confidential Names List). The date of death is listed as 3/7/2022 , and C1 passed away at the 3/7/2022.

LPA obtained additional information on this date. All clients observed appeared appropriate for the facility. All staff the LPA interacted with had a current criminal record clearance. No immediate health or safety issues were identified.

No deficiencies were cited or observed on this date.

The Licensee was provided a copy of their appeal rights (LIC9058 01/16), and her signature on this form, acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided to Elizabeth Enriquez
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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