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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 12/15/2022
Date Signed: 12/19/2022 11:21:22 AM


Document Has Been Signed on 12/19/2022 11:21 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:VISTA GARDENSFACILITY NUMBER:
374604198
ADMINISTRATOR:JAMES MCALEERFACILITY TYPE:
740
ADDRESS:1863 DEVON PLACETELEPHONE:
(760) 295-3900
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:99CENSUS: 76DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:BUSINESS COORDINATOR, KARINA TELLEZ.TIME COMPLETED:
03:30 PM
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Due to a computer malfunction, a handwritten report had to be issued. This is an exact duplicate of that handwritten report. See handwritten document in file for original signatures.

On December 15, 2022, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility to conduct an unannounced case management concern. LPA Mixson was greeted and granted entry by Business Coordinator introduced self and explained the purpose of the visit.

LPA Mixson met with Business Coordinator, Karina Tellez, toured the facility and requested and obtained pertinent documentation. There were no concerns or issues observed on todays visit.

LPA Mixson later held a phone conversation with LPM Joel Esquivel. Rachel McIntier and LPA Mixson were present in the office at the facility and LPM Esquivel was on the phone on speaker. The conversation summary;
a). Proper communication with outside departments on the process of COVID.
b). Rachel McIntier will be the new facility Health and Well ness Director.
c). Rachel McIntier will be the lead going forward. In addition the facility will
submit a packet for a change of Administrator, by January 14, 2023.
d). The Administrator will submit the information log to the Department of
Public Health by 12/16/2022.
An exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022
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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