<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604033
Report Date: 12/30/2021
Date Signed: 12/31/2021 09:09:39 AM

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:GRAND VILLA 2FACILITY NUMBER:
374604033
ADMINISTRATOR:MALCHOW, LAURAFACILITY TYPE:
740
ADDRESS:1995 SUNSET DRIVETELEPHONE:
(858) 231-3933
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 4DATE:
12/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator Laura MalchowTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Sabel Martinez, and County of San Diego COVID Site Nurse Investigator, Sandra Brackman, conducted an on-site visit. LPA and Nurse identified themselves and discussed the purpose of the visit with Administrator, Laura Malchow.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. During today's visit, the Nurse interviewed Administrator Malchow. The Nurse conducted a walk-though of the facility. A debriefing was conducted with Administrator Malchow at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Administrator Malchow and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Administrator Malchow via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1