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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603529
Report Date: 10/13/2022
Date Signed: 10/14/2022 08:59:12 AM


Document Has Been Signed on 10/14/2022 08:59 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:MISSION VILLA EASTFACILITY NUMBER:
374603529
ADMINISTRATOR:ROSEMARIE LIMPINFACILITY TYPE:
740
ADDRESS:2337 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 501-1788
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY:6CENSUS: 4DATE:
10/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Administrator, Alexander LimpinTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to follow-up and provide guidance on observations made during a complaint visit LPA discussed the purpose of the visit with Administrator, Limpin.

During a complaint visit, LPA provided guidance to facility staff regarding visitation policies, medication management, safety guidelines for care and supervision, staffing requirements, and record keeping. In addition, LPA discussed reporting requirements to CCL.

An exit interview was conducted with Administrator, Limpin, to whom a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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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