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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604063
Report Date: 12/03/2024
Date Signed: 12/04/2024 11:58:54 AM

Document Has Been Signed on 12/04/2024 11:58 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MESAVIEW SENIOR ASSISTED LIVINGFACILITY NUMBER:
374604063
ADMINISTRATOR/
DIRECTOR:		GENOVEVA GUERREROFACILITY TYPE:
740
ADDRESS:7971 CULOWEE STREETTELEPHONE:
(619) 466-0253
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 28DATE:
12/03/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Genoveva Guerrero AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:03 AM
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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced collateral visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Genoveva Guerrero, Administrator.

This visit is to Amend a visit with Resident 1. The administrator informed LPA that the Resident was currently out in the community.

LPA Domingo thanked the administrator for her time and did not conduct a tour or any interviews at this time.

An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22) were left with the Executive Director, whose signature on this form confirms receipt of these documents.
Simon JacobTELEPHONE: (619) -76-2306
Amy DomingoTELEPHONE: 619-767-2301
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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