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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604065
Report Date: 03/15/2021
Date Signed: 03/15/2021 12:20:40 PM

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:LAS VILLAS DE CARLSBADFACILITY NUMBER:
374604065
ADMINISTRATOR:DONELLE WILLIAMSFACILITY TYPE:
740
ADDRESS:1088 LAGUNA DRIVETELEPHONE:
(760) 434-7116
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:214CENSUS: 91DATE:
03/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Administrator, Donelle WilliamsTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Kristina Ryan conducted an unannounced case management virtual visit, due to the COVID-19 pandemic. LPA identified herself and stated the purpose of the visit to Administrator Donelle Williams and Assistant Administrator James Ringhoff.

The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on March 12,2021. The facility reported that on March 11, 2021, R1 left the facility (AWOL) and was returned to the facility by law enforcement.

On today’s date, LPA toured the facility and conducted a health and safety check. LPA requested copies of additional facility records and interviewed staff. No deficiencies were cited at this time.

An exit interview was conducted with the Administrator Donelle Williams and Assistant Administrator James Ringhoff, to whom a copy of this report, LIC811 Confidential Names list, and the LIC9058 Licensee/Appeal Rights were provided via E-mail. An electronic read receipt verifies receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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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