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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603565
Report Date: 01/21/2022
Date Signed: 01/21/2022 10:22:41 AM

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: DATE:
01/21/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Daniel SlaughterTIME COMPLETED:
10:59 AM
NARRATIVE
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Licensing Program Analyst (LPA) Kennedy and County of San Diego Nurse Contractors, Sandra Brackman with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Daniel Slaughter, Administrator and Cristi Ostreng, Director of Assisted Living.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Administrator and Director of Assisted Living and conducted a walk-though of the facility. A debriefing was conducted at the conclusion of the visit.

During today's visit, no deficiencies were cited.  An exit interview was conducted with the Daniel Slaughter, Administrator. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the facility via electronic mail.  An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2022
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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