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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603713
Report Date: 01/14/2022
Date Signed: 01/14/2022 04:32:24 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:PARKVIEW MEMORY CARE AT PARADISE VILLAGEFACILITY NUMBER:
374603713
ADMINISTRATOR:LAWSON, WILLIAMFACILITY TYPE:
740
ADDRESS:735 ARCADIA AVENUETELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:70CENSUS: 46DATE:
01/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator, Geovanni AguilarTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno, and County of San Diego Senior Public Health Nurses, Robert Montellano and Sandra Brackman , conducted an in-person visit.

LPA and Nurses Montellano and Brackman identified themselves and discussed the purpose of the visit with Administrator, Geovanni Aguilar and Executive Director, William Lawson.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection and screening protocols. During today's visit, the team interviewed the Administrator and provided consultation and conducted a walk-though of the facility. A debriefing was conducted with the Administrator and Executive Director at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Administrator, Aguilar, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2022
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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