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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 12/15/2020
Date Signed: 12/15/2020 10:37:38 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 NORTEFACILITY NUMBER:
374604294
ADMINISTRATOR:FARISH, JOLENEFACILITY TYPE:
740
ADDRESS:1325 LAS VILLAS WAYTELEPHONE:
(760) 741-1047
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:236CENSUS: 157DATE:
12/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Jolene Farish, AdministratorTIME COMPLETED:
10:34 AM
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Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced Case Management tele-visit on today's date via FaceTime due to COVID-19. LPA Hamer identified himself and discussed the purpose of the visit with Jolene Farish, Administrator.

The purpose of the visit was to follow up on an Incident Report received in our office on 11/24/2020. During today’s visit, LPA Hamer interviewed Ms. Farish and requested copies of resident and staff records. No deficiencies were cited on this date.

An exit interview was conducted with Ms. Farish and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email. An electronic email read receipt confirms receipt of these documents..
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam HamerTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2020
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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