374604294-5-19-2020-08-AS-AHAR-BPRLT9-20200519090154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 04/20/2020
Date Signed: 05/19/2020 09:03:00 AM

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:	LAS VILLAS DEL NORTE		FACILITY NUMBER:	374604294
ADMINISTRATOR:	FARISH, JOLENE		FACILITY TYPE:	740
ADDRESS:	1325 LAS VILLAS WAY		TELEPHONE:	(760) 741-1047
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	236	CENSUS: 156	DATE:	04/20/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jolene Farish		TIME COMPLETED:	04:30 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 Analyst (LPA) Adam Hamer made an announced Pre-Licensing and Component III inspection visit to the facility on today's date. Since this is a change of ownership visit, there are currently clients in care at the facility. The facility was inspected by the City of Escondido Fire Department on February 13, 2020. The facility was approved for 236 residents - 150 non-ambulatory and 86 bedridden. The facility has a sprinkler system. The main building on the first floor is approved for the bedridden residents. LPA met with Executive Director Jolene Farish. via FaceTime due to COVID-19 restrictions. LPA conducted a tour of the facility with Farish which included inspection of apartments on campus, common areas and grounds. There are 186 apartments on campus. Each unit has a private bathroom that have either a tub cut or a walk-in shower, with the exception of the bathrooms in the dementia unit. The campus consists of three buildings - Las Villas Del Norte, Health Center and Norte Villas. There are elevators available for each main building which has three floors. The dementia unit has magnetic locked doors and secured/locked perimeter approved by the Fire Department. Facility also has functioning smoke detectors and carbon monoxide detectors. There is a pool at the facility with locked self-latching gates adjacent to the laundry area outside of the Las Villas Del Norte building. The facility has the appropriate linen and supplies for the resident rooms. There is a reception area with offices, conference room and a restroom for visitors. There is an in-house dining service director/chef that oversees the menus to ensure the nutritional needs are being met and that the facility is in compliance with regulations. There are three dining areas on the campus. The facility uses professional rolling hot box carts to transport from the main kitchen/dining area to the additional areas.

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020

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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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: LAS VILLAS DEL NORTE	FACILITY NUMBER: 374604294
	VISIT DATE: 04/20/2020

NARRATIVE

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LPA checked the facility kitchen which was clean with all functioning industrial appliances. The kitchen was also fully stocked with the supplies to provide the required food service to the residents in care. The water temperature was within regulation of 105 to 120 degrees Fahrenheit. LPA observed the food that was being prepared for the residents for dinner. The food was covered, dated, marked and stored in accordance with regulation. There was over a seven day supply of perishable and 2 day supply of non-perishable foods. Although there is plenty of space at the facility to conduct activities for the residents, there were no activities taking place due to current social distancing protocol related to COVID-19.

LPA checked the temperature on the thermostat at the facility and in dementia care at 79 and 78 degrees Fahrenheit in the main Las Villlas Del Norte building and the memory care unit, respectively, which are within the range designated under the regulations. The walls, ceiling and floors appeared to be clean and in good repair. The window screens also appeared to be in good condition. There are housekeeping utility rooms on campus where chemicals are stored and locked. The facility also has locked medication rooms with 24/7 LVN care for the residents. There are also first aid supplies with all the required items kept at the facility. Facility maintains locked resident records and staff records in the Executive Director's office and in the Business Office Director's office. Prior to COVID-19 restrictions, facility had regularly scheduled resident council meeting. LPA discussed regulations and reporting requirements, including mandated reporter.

LPA completed the Pre-Licensing and Component III visit with Farish, reviewed this report and Appeal Rights (LIC 9058 (FAS 01/16)) with her, and emailed a copy to the email address she provided to LPA. Farish then acknowledged receipt of the emailed documents.

SUPERVISOR'S NAME: Tony Girolami	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2020

LIC809 (FAS) - (06/04)

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