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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 02/08/2024
Date Signed: 02/08/2024 10:16:58 AM


Document Has Been Signed on 02/08/2024 10:16 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: 88DATE:
02/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:HEALTH AND WELLNESS DIRECTOR, RACHEL MCINTYRETIME COMPLETED:
10:22 AM
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On February 08, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management Immediate Exclusion Order and met with Rachel McIntyre, Health and Wellness Director (HWD). LPA informed HWD of the purpose of the visit.

LPA Mixson toured the facility, along with the Health and Wellness Director and made observations pertaining to the immediate exclusion of Staff #1 (S1), in regards to Background Check ID: 7120812. There were no visual sighting of S1 present at the time of this case management visit. There are no imminent health and/or safety concerns observed at the time of visit. The LPA requested and received pertinent documentation, and made record reviews.

LPA Mixson asked the Wellness Director if the listed individual is associated to another facility operated by the same license and the LPA was informed that S1 was not.

Based on the information obtained during today's Immediate Exclusion verification visit, The LPA has verified that S1 was not observed or noted on the staff roster to be present at the time of this visit. It is confirmed based on record reviews, observations and interviews the listed individual is not currently present or employed, or residing at the facility currently at the time of this visit. LPA Mixson has advised the Licensee to disassociate the Individual from the roster and to submit an updated LIC 500.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to the Wellness Director, Rachel Mcintyre.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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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