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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604198
Report Date: 09/28/2022
Date Signed: 09/28/2022 10:35:34 AM


Document Has Been Signed on 09/28/2022 10:35 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: 87DATE:
09/28/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:ADMINISTRATOR, RACHEL MCINTYRETIME COMPLETED:
10:35 AM
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On September 28, 2022, Licensing Program Analyst (LPA), Venus Mixson, conducted an unannounced visit to the facility to conduct a case management / Health and Safety visit. LPA Mixson met with Administrator, Rachel Mcintyre.

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 did not observe any Health and/or Safety concerns at this time. There were no issues or concerns observed.

LPA Mixson also requested staff and client rosters. Documents were received.

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: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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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