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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 02/25/2021
Date Signed: 06/11/2021 10:20:13 AM

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:VISTA GARDENSFACILITY NUMBER:
374604198
ADMINISTRATOR:DELGADO, EVELYNFACILITY TYPE:
740
ADDRESS:1863 DEVON PLACETELEPHONE:
(760) 295-3900
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:99CENSUS: 59DATE:
02/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Evelyn Delgado, Executive DirectorTIME COMPLETED:
12:18 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced Case Management visit via virtual communication due to COVID-19. LPA spoke with Evelyn Delgado, Executive Director, via FaceTime. LPA identified herself, conducted a virtual tour and explained the purpose of the call.

The virtual visit was in response to a self reported SOC341 received February 22, 2021, for Client 1 (C1 – see LIC811 Confidential Names List) and Staff 1 (S1 – see LIC811 Confidential Names List).

LPA Lopez advised Executive Director Delgado that at this time the Case Management visit requires further review and requested additional documentation. Possible follow-up telephone calls or visits are necessary before a determination can be made.

No deficiencies were cited during today’s virtual visit.

An exit interview was conducted with Executive Director Evelyn Delgado via virtual call and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Executive Director Delgado via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021
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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