374604294-2-10-2021-08-AS-AHAR-BY4VHR-20210210152735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 02/10/2021
Date Signed: 02/10/2021 03:27:42 PM

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: 152	DATE:	02/10/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Jolene Farish, Administrator		TIME COMPLETED:	03:20 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	On today's date, Licensing Program Analyst (LPA) Adam Hamer conducted a Case Management tele-visit with Administrator Jolene Farish via FaceTime due to COVID-19. LPA identified himself to Ms. Farish and discussed the purpose of the visit. Licensee initiated a Change of Capacity application which was initially received by the Department on August 24, 2020 and subsequently amended. Then, a Fire Safety Inspection Request was requested by the Department on December 15, 2020. Today, LPA toured the entire property inside and out to inspect the areas of reduced capacity. Change of Capacity: Old capacity: 236 New capacity: 198 Facility shall serve one-hundred and ninety-eight (198) elderly clients, ages sixty (60) and above. One-hundred and twelve (112) of whom may be non-ambulatory and eighty-six (86) of whom may be bedridden. Inspection: During today's inspection, LPA observed the following: all indoor and outdoor passageways were free from obstructions; According to Ms. Farish, there are no firearms or ammunition present on the premises; Hot water temperature for bathrooms used by residents that were inspected measured at 109.2 and 106.6 degrees Fahrenheit, and ambient air was measured at 77 degrees Fahrenheit; All resident rooms inspected had smoke detectors and there were carbon monoxide detectors on the third floor of the facility; Resident rooms are maintained by housekeeping staff and were observed today to be clean, well-kempt and in sanitary condition; and Medications were centrally stored and locked.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

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: 02/10/2021

NARRATIVE

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During today's tele-visit, no immediate health and safety concerns were observed and there were no deficiencies. The facility sketch/floor plan was consistent with the current layout and accommodations at the facility. Approval notification to Licensee will be made by Community Care Licensing Division, and a new license will be mailed to Licensee after final approval.

An exit interview was conducted with Ms. Farish via FaceTime, and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email; an email read receipt confirms receipt of said documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Adam Hamer	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021

LIC809 (FAS) - (06/04)

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