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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 06/14/2024
Date Signed: 06/14/2024 09:35:34 AM


Document Has Been Signed on 06/14/2024 09:35 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
RIVERSIDE ASC, 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: 121DATE:
06/14/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrative Executive Director, Reu BaggaoTIME COMPLETED:
09:40 AM
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On 6/14/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced case management visit at the facility to follow up on concerns identified in the Non-Compliance Conference (NCC) held on 10/20/2023. LPA met with Administrative Executive Director (AED), Reu Baggao who was informed of the purpose of the visit.

LPA conducted a walk-through of the facility with Administrative AED Baggao for any health or safety concerns. During the tour, LPA observed residents relaxing in their rooms and in common areas. The facility was working utilities, required food supply, and adequate staffing. During today's visit, LPA did not observe any health or safety concerns as identified on the NCC held on 10/20/2023. An exit interview was conducted and a copy this report was reviewed and provided to AED Baggao.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024
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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