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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 12/29/2023
Date Signed: 12/29/2023 11:31:31 AM


Document Has Been Signed on 12/29/2023 11:31 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



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:198CENSUS: 198DATE:
12/29/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:RESIDENTIAL CARE COORDINATOR(RCC), NORMALIN PAULOTIME COMPLETED:
11:45 AM
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On December 29, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced case management Health and Safety Check. LPA Mixson met with the Residential Care Coordinator, Normalin Paulo and introduced herself and stated the purpose of the visit.

Today's visit is in response to previous information received by Community Care Licensing regarding the health and safety of the residents in care.

LPA Mixson conducted a Health and Safety check at the facility. There were no health or safety issues identified. LPA Mixson requested and received pertinent documents. LPA Mixson observed a sample of the residents rooms and the rooms had the required furnishings per the regulations. There were sufficient staff to resident for supervision and the staff were engaging the residents in activities, the meal of the day, and medications were being distributed. LPA Mixson interviewed the facility nurse and the asked who is in charge of bathing the residents and the nurse stated there are four caregivers, one nurse, and two med techs on the assisted living side. They get assistance about twice a week but some residents only request for once a week. There are some residents who may be scheduled for three times a week but they have the right to refuse and if they do refuse it is logged. There were no deficiencies observed or cited during this visit.
An exit interview was conducted and a copy of this report was provided to the RCC, Normalin Paulo.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/29/2023
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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