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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603565
Report Date: 07/23/2021
Date Signed: 07/23/2021 04:22:45 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:LA VIDA REALFACILITY NUMBER:
374603565
ADMINISTRATOR:KIMBERLY GARCIAFACILITY TYPE:
740
ADDRESS:11588 VIA RANCHO SAN DIEGOTELEPHONE:
(619) 660-5778
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:177CENSUS: 103DATE:
07/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Daniel SlaughterTIME COMPLETED:
04:38 PM
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Licensing Program Analyst (LPA) Kennedy conducted a case management visit regarding an incident report that was received in the office on 7-19-21 for Resident 1 (R1) AWOL. LPA identified herself and explained the purpose of visit to Daniel Slaughter Executive Director. The purpose of this visit was to follow up on the AWOL of Resident 1. (See LIC 811 Confidential Names)

During the visit, LPA toured the facility and conducted interviews and reviewed records.

When R1 was checked on for evening medications and was not found in their room. This was unusual for R1. A search was convened and R1 was located unharmed about a block away. R1 was disoriented when located. Although R1 was allowed to be in the community unassisted, this behavior was a change in condition. Facility took steps to keep R1 safe and a new assessment in planned.

No deficiencies cited today during visit.

An exit interview was conducted with Daniel Slaughter Executive Director. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Mr. Slaughter via email. An electronic response confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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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