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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604092
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:36:23 AM


Document Has Been Signed on 11/21/2022 11:36 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:SENIOR LIVING NORWOODS HACIENDAFACILITY NUMBER:
374604092
ADMINISTRATOR:PETROSYAN, ANNAFACILITY TYPE:
740
ADDRESS:35 EL RANCHO VISTATELEPHONE:
(818) 284-2502
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 6DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Head Caregiver, Jonathan TorresTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced case management visit at the facility. LPA was greeted at the front entrance by Caregiver, Elena Marrufo and granted entry after identifying herself. LPA met with Head Caregiver, Jonathan Torres and explained the purpose of the visit which was unrelated to another visit at the facility.

During this visit, LPA observed a pool on the property with the gate unlocked and open. LPA reviewed Title 22, Division 6, Chapter 8, Article 05, Physical Environments and Accommodations, Section 87307, Personal Accommodations and Services. LPA advised the Head Caregiver that facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility to swimming pools or similar bodies of water, when not in active use. Technical Advisory given.

An exit interview was conducted with Head Caregiver and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2022
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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