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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603530
Report Date: 10/13/2022
Date Signed: 10/13/2022 04:59:36 PM


Document Has Been Signed on 10/13/2022 04:59 PM - 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 WESTFACILITY NUMBER:
374603530
ADMINISTRATOR:MARIA WILLIAMSFACILITY TYPE:
740
ADDRESS:2335 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 501-1244
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY:6CENSUS: 5DATE:
10/13/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Administrator, Alexander LimpinTIME COMPLETED:
03:55 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a collateral visit to conduct a welfare check on residents in care. LPA discussed the purpose of the visit with Administrator, Limpin.

During the visit LPA toured the facility, observed and interacted with residents in care. No safety violations were observed during the visit.

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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