374603770-6-16-2023-08-AS-RGAZ-CSUP9C-20230616110657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603770
Report Date: 06/16/2023
Date Signed: 06/16/2023 11:07:14 AM

Document Has Been Signed on 06/16/2023 11:07 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:	VILLA SAN ANGELA		FACILITY NUMBER:	374603770
ADMINISTRATOR:	ENRIQUEZ, RICHARD		FACILITY TYPE:	735
ADDRESS:	1857 DIESEL DRIVE		TELEPHONE:	(619) 948-9177
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY: 4		CENSUS: 4	DATE:	06/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Administrator Elizabeth Enriquez		TIME COMPLETED:	11:15 AM

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Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Shayla Saunders, LVN.

According to the facility’s license, the facility has a maximum capacity of four (4) non-ambulatory clients. During today’s inspection,all four (4) clients are in care, and per medical records, one (1) was ambulatory and three (3) were non-ambulatory. Facility is approved for locked perimeter and delayed egress.

LPA, accompanied by Administrator Elizabeth Enriquez, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 76 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 109.7 F, Bathroom #1 sink was 112.2 F, and Bathroom #2 sink was 110.5 F.

Refrigerator temperature was 39 F and freezer temperature was 0 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUE TO LIC 809-C]

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VILLA SAN ANGELA	FACILITY NUMBER: 374603770
	VISIT DATE: 06/16/2023

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[CONTINUED FROM LIC 809]

No pools or bodies of water were observed on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (2) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and one (1) client. The interviews did not raise any significant licensing concerns. LPA reviewed multiple staff and client records/files. The reviewed files contained required documents. Confidential records were stored in locked areas. Administrator presented proof of current/active business liability insurance and surety bond.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Enriquez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC809 (FAS) - (06/04)

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