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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603770
Report Date: 06/09/2022
Date Signed: 06/09/2022 05:00:34 PM

Document Has Been Signed on 06/09/2022 05:00 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:VILLA SAN ANGELAFACILITY NUMBER:
374603770
ADMINISTRATOR:ENRIQUEZ, RICHARDFACILITY TYPE:
735
ADDRESS:1857 DIESEL DRIVETELEPHONE:
(619) 948-9177
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 4DATE:
06/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:18 PM
MET WITH:Elizabeth Enriquez, AdministratorTIME COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Lucha Dias, House Manager. LPA met with Administrator Elizabeth Enriquez and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA accompanied by Administrator Enriquez conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, clients and visitors; posted signs regarding visitor policy, promoting hand washing/hand hygiene practices, cough and sneeze etiquette and other infection control procedures; testing plan and procedures for staff and clients; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Administrator Enriquez. A copy of this report, along with the Licensee Rights (01/2016) was provided to Administrator Enriquez at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.

LPA received a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-D was provided to LPA while at the facility. Forms are available at www.ccld.ca.gov.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
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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