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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 11/17/2023
Date Signed: 11/17/2023 11:02:56 AM


Document Has Been Signed on 11/17/2023 11:02 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:SANCHEZ, PAZ HILDAFACILITY TYPE:
740
ADDRESS:1863 DEVON PLACETELEPHONE:
(760) 295-3900
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:99CENSUS: 86DATE:
11/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:RESIDENT SERVICE DIRECTOR, RACHEL MCINTRYETIME COMPLETED:
11:12 AM
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On November 17, 2023, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct an annual licensing inspection, and met with the Resident Service Director, Rachel. The LPA introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility along with the Rachel, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is licensed to serve 99 senior residents, but currently is operating at 86 residents.
Physical Plant: The facility is located at 1863 Devon Place Vista, Ca. 92028, and the facility phone number is (760) 295-3900, and is operable. The LPA observed a sample of the resident's living units, and those were equipped with required furniture as per Title 22. The LPA inspected a sample of the facility restrooms, and the Resident Service Director stated the hot water temperature is tested by the maintenance department and is logged monthly, it test within regulations. The restrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers, and a first aid kit with manual. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated space for the resident and staff files. Medications: The medications were, locked, and inaccessible to the residents in the nurses station. The overall facility is clean, and the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there were a variety of food types. Dishes and utensils are in sufficient supply and stored properly. Care & Supervision: The Facility has sufficient staff, 35 or 40 at the time of this visit, and the staff were attentive and engaging the residents. Records Review: The LPA reviewed nine resident files, eight staff files, and conducted three staff interviews. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit. An exit interview was conducted and a copy of this report was given to the Resident Services Director, Rachel Mcintyre.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023
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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