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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604215
Report Date: 02/27/2023
Date Signed: 02/27/2023 01:48:09 PM


Document Has Been Signed on 02/27/2023 01:48 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:VILLA FLORENZAFACILITY NUMBER:
374604215
ADMINISTRATOR:ALVI, ZOHAIBFACILITY TYPE:
740
ADDRESS:5171 ALAMOSA PARK DRIVETELEPHONE:
(480) 326-6082
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:6CENSUS: 5DATE:
02/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator, Zohaib AlviTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to cite for a violation investigated during a separate complaint. LPA discussed the purpose of the visit with Administrator, Zohaib Alvi.

On February 22, 2023, a review of the Admissions Agreement indicated that it contained provisions that violate the rights of residents. The facility’s policy for reimbursement was stated in the Admission Agreement as, “in the event, where/if resident expires before the 10th of the month, POA will only receive the refund for the second half of the month. The resident dies on or after the 10th of the month, there will be no refund applicable in that case”. However, according to Title 22 regulations, admission agreements shall not contain any provision that violates the rights of any residents, including refund of fees paid.

Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC809D and a plan of correction was jointly developed with Administrator. Zohaib Alvi.

An exit interview was conducted with Administrator, Alvi, to whom a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
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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Document Has Been Signed on 02/27/2023 01:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: VILLA FLORENZA
FACILITY NUMBER: 374604215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2023
Section Cited

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87507(h)(4) Admission Agreement
Admission Agreements: (h)The admission agreement shall not contain...: (4) Any provision that violates the rights of any residents...specified...in Health and Safety Code section 1569 et seq. This requirement was not met by:
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Licensee agreed to revise the Admission Agreement to not include provisions that violates the rights of any residents per HSC section 1569 et seq. Licensee will submit a revised Admission Agreement to CCL for review and approval by POC date of 3/15/2023,
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Based on interviews and record review, the licensee included unlawful provisions in the Admissions Agreement which posed a personal rights risk to x of x residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
LIC809 (FAS) - (06/04)
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