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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604269
Report Date: 02/22/2022
Date Signed: 02/22/2022 06:00:41 PM


Document Has Been Signed on 02/22/2022 06:00 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:FELICITA VIDAFACILITY NUMBER:
374604269
ADMINISTRATOR:MALASPINA, KIMBERLYFACILITY TYPE:
740
ADDRESS:930 MONTICELLO DRIVETELEPHONE:
(760) 747-4888
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY:123CENSUS: 1DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator Kim MalaspinaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Kayla Hilario, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Administrator, Kim Malaspina, and we discussed the purpose of the visit. All staff with whom LPA interacted have a current criminal record clearance.

LPA conducted a tour of the facility, both inside and outside and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

The Licensee will be provided a copy of their appeal rights (LIC9058 01/16). An exit interview was conducted with the Administrator, Kim Malaspina, and a copy of this report will be emailed to the Licensee with an electronic read receipt as confirmation of documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: 619-481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
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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