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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603908
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:18:06 PM


Document Has Been Signed on 01/11/2023 02:18 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GRAND VILLAFACILITY NUMBER:
374603908
ADMINISTRATOR:MALCHOW, LAURAFACILITY TYPE:
740
ADDRESS:300 AMPARO DRTELEPHONE:
(760) 294-2006
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
01/11/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Laura Malchow, AdministratorTIME COMPLETED:
02:25 PM
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On January 11, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to deliver complaint investigation findings for Grand Villa 2 facility that is already closed. LPA Nwogene met with Administrator, Laura Malchow who was informed of the purpose of the visit.

During today's visit, a copy of the complaint report was reviewed with and provided along with appeal rights to Laura.

An exit interview was conducted were this report was discussed with and provided to Laura Malchow.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
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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