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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 01/23/2024
Date Signed: 01/23/2024 01:57:24 PM


Document Has Been Signed on 01/23/2024 01:57 PM - 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,
, CA



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: DATE:
01/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Rachel McIntyre, Health and Wellness DirectorTIME COMPLETED:
01:03 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit to deliver an Amended Report for a visit conducted on 11/02/2023. LPA Lopez met with Rachel McIntyre, Health and Wellness Director (HWD) and informed her of the purpose of the visit.

During today’s visit, LPA obtained HWD McIntyre’s signature on the amended report LIC 9099 dated (01/23/2024) and deficiencies were issued on the attached LIC9099-D.

An exit interview was conducted and a copy of this report along with the Licensee’s Rights (LIC 9058 03/22) was provided to Health and Wellness Director Rachel McIntyre at the conclusion of the visit. The signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2024
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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