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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603565
Report Date: 05/12/2023
Date Signed: 05/12/2023 11:27:57 AM


Document Has Been Signed on 05/12/2023 11:27 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
SO. CAL AC/SC, 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: 41DATE:
05/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Enliven Director Kristen Molina and Assistant Director Cristi OstrengTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced case management visit to follow-up on an incident reported to Community Care Licensing. LPA introduced herself, was granted entry into the facility, and met with Assistant Director Cristi Ostreng and Enliven Director Kristen Molina, to to whom she disclosed the purpose of the visit.

Community Care Licensing received an incident report on May 10, 2023, in which it was reported that Resident 1 (R1) [Staff was provided an LIC 811 Confidential Names List that identifies the client] went absent without official leave (AWOL) from the facility on May 10, 2023 and was returned on the same day.

During today's visit, LPA conducted a health and safety check, interviewed staff, and obtained copies of facility records. LPA spoke briefly with Resident 1 (R1). No deficiencies were cited during the visit.

An exit interview was conducted with Ostreng and Molina and a copy of this report and Licensee Appeal Rights (LIC 9058) were provided to the licensee at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa RamirezTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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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