374604215-12-28-2023-08-AS-MMAL-CYY2GU-20231228162344

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604215
Report Date: 12/28/2023
Date Signed: 12/28/2023 04:23:55 PM

Document Has Been Signed on 12/28/2023 04:23 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:	VILLA FLORENZA		FACILITY NUMBER:	374604215
ADMINISTRATOR:	ALVI, ZOHAIB		FACILITY TYPE:	740
ADDRESS:	5171 ALAMOSA PARK DRIVE		TELEPHONE:	(480) 326-6082
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY:	6	CENSUS: 6	DATE:	12/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Adminstrator, Muhammad Alvi		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Mark Mandel and Daniel Pena conducted an unannounced visit to the facility. The purpose of the visit was to complete a One-year Required Annual inspection. LPA Mandel reviewed the facility file prior to inspection. LPAs were granted entry into the facility by Nian Hamto, Caregiver after identifying themselves and stating the purpose of the inspection. Administrator, Muhammad Alvi later joined LPAs. All staff present received criminal history clearance. Per the license, the facility is approved to serve six (6) non-ambulatory elderly adults, age range 60 and over. Hospice waiver for six (6). At the time of the visit, the facility had six (6) residents in care and two (2) staff present. The facility sketch was reviewed and is consistent with the layout of the facility. The fire inspection requirements for non-ambulatory residents is in accordance with the approved fire inspection. LPAs, accompanied by Caregiver, Roy Antes, conducted a tour of the facility, inside and out. During today’s inspection, the facility’s ambient temperature was measured at 73 degrees F. Carbon monoxide detector and smoke alarms were operational and met statutory standards. No pools or bodies of water were observed. Exterior and interior passageways were free from obstructions. According to Administrator Alvi, there are no weapons and/or ammunition stored on the premises. Disinfectants and cleaning solutions are inaccessible to residents, and poisons are locked. Each resident had clean linen in good repair and sufficient hygiene products for personal use. All residents’ rooms were equipped with required furnishings to meet their needs. There are sufficient lamps or lights in all rooms. Resident bathrooms contain the required furnishings and were in a safe, sanitary, and operational condition. Hot water temperature at faucets for residents’ use were measured at 105.5 degrees and 110. degrees Fahrenheit. Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VILLA FLORENZA	FACILITY NUMBER: 374604215
	VISIT DATE: 12/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

observed to be properly stored. Medications were stored in a safe and locked place and were labeled and kept in compliance with label instructions.

Employee records review verified that all staff have Criminal Record Clearance, Criminal Record Statement, and required training. Resident records reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan (IPP), Admissions Agreement, and Centrally Stored Medication. The facility conducts emergency drills regularly and the last one was conducted on November 27, 2023. The emergency disaster plan was observed and reviewed.

Based on today’s inspection, no deficiencies were observed in the areas evaluated. An exit interview was conducted and a copy of this report and Licensee Rights - LIC 9058 (rev. 01/16) were provided to Administrator, Alvi, whose signature on this form acknowledges receipt of these documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Mark Mandel	TELEPHONE: 619-990-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2