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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604204
Report Date: 11/20/2024
Date Signed: 11/20/2024 12:54:08 PM

Document Has Been Signed on 11/20/2024 12:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LA VALHALLA RESIDENTIAL CAREFACILITY NUMBER:
374604204
ADMINISTRATOR/
DIRECTOR:
DE VERA, JONATHANFACILITY TYPE:
740
ADDRESS:1701 LA VALHALLA PLTELEPHONE:
(619) 499-5853
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Adminstrator Jonathan De Vera TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rowena Ramos. Administrator Jonathan De Vera arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of all whom may be non-ambulatory and one of which may be bedridden.

LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas.



No pools or bodies of water on the premises. Per Jonathan, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kits were complete and readily accessible.

No deficiencies were cited on today's visit. LPA provided consultation during the inspection regarding volunteers at the facility.

An exit interview was conducted with Administrator Jonathan De Vera, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Simon JacobTELEPHONE: (619) -76-2306
Iby StrongTELEPHONE: 619-481-0846
DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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