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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 07/12/2022
Date Signed: 07/12/2022 11:36:48 AM


Document Has Been Signed on 07/12/2022 11:36 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: 79DATE:
07/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Director Wayne Lilly TIME COMPLETED:
11:36 AM
NARRATIVE
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Licensing Program Analyst (LPA), Venus Mixson, conducted an unannounced visit to the facility to conduct a case management / Health and Safety visit. LPA Mixson was greeted and granted entry by Director, Wayne Lilly.

LPA Mixson conducted a tour of the facility and observed that the facility is clean, has adequate food, utilities are on, and there is running water, as observed through restroom and kitchen area. LPA Mixson later met with Administrator, Rachel McIntyre and was granted access to interview clients and staff. LPA Mixson interviewed five clients and three staff. There were no issues or concerns advised.

LPA Mixson requested documentation showing ownership of the property and utility payments. Administrator stated the requested documents are at the corporate office and that they could email those to LPA by Friday, 7/15/2022. LPA Mixson also requested staff and client rosters. Documents were received.

LPA Mixson did not observe any issues or concerns pertaining to utilities, food, or staffing issues during the inspection. An exit interview was conducted a copy of this report, along with LIC 811, was given to the Administrator.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2022
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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