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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603862
Report Date: 06/11/2024
Date Signed: 06/11/2024 05:20:15 PM

Document Has Been Signed on 06/11/2024 05:20 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VILLA SANTA ROSAFACILITY NUMBER:
374603862
ADMINISTRATOR/
DIRECTOR:		ENRIQUEZ,RICHARDFACILITY TYPE:
735
ADDRESS:4516 PASEO DE LA VISTATELEPHONE:
(619) 948-9177
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 4CENSUS: 4DATE:
06/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Direct Support Professional, Elizabeth EnriquezTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required 1-Year Visit. LPA was greeted by, Direct Support Professional (DSP), Elizabeth Enriquez, to whom she identified herself and discussed the purpose of the visit. All staff present have a current criminal record clearance. The facility Administrator, Juan Miguel Ruiz, had a current administrator certificate on file with expiration date January 26, 2026.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of which all may be non-ambulatory. The facility is approved for delayed egress. There was a total of four (4) clients in care, one (1) of which was non-ambulatory.

LPA, accompanied by DSP, 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. Clients’ bedrooms contained the required furnishings. Doors, windows, 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.

There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Grocery shopping is conducted twice per week. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled as required and stored in locked areas.

(Continue at LIC809C)
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: VILLA SANTA ROSA
FACILITY NUMBER: 374603862
VISIT DATE: 06/11/2024
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(continue from LIC809)

The facility had no pools of water on the premises. Per staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Two (2) fire extinguishers were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. The room temperature in the facility was comfortable at 71 degrees. All staff have current First Aid Certificates. The facility conducted emergency drills as required, the last emergency drill was conducted on May 22, 2024, and Earthquake drill on February 14, 2024. Liability insurance was current, with an expiration date of 2/18/2025. The kitchen sink water accessible to clients was measured 112 F on 6/10/2021, LPA confirmed facility staff checks the water temperature monthly.

LPA interviewed staff and reviewed multiple staff and client records/files. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in locked areas. Training records for staff were current as required per Title 22 regulations.

No violations were observed during today’s visit.

An exit interview was conducted with DSP, Enriquez to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
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