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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604294
Report Date: 09/29/2021
Date Signed: 10/04/2021 02:24:52 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 NORTEFACILITY NUMBER:
374604294
ADMINISTRATOR:FARISH, JOLENEFACILITY TYPE:
740
ADDRESS:1325 LAS VILLAS WAYTELEPHONE:
(760) 741-1047
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:198CENSUS: 157DATE:
09/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Executive Director Jolene FarishTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Liliana Silveira and Licensing Program Manager (LPM) Denise Powell conducted an unannounced case management visit. LPA and LPM identified themselves and stated the purpose of the visit to Executive Director Jolene Farish.

The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on 09/21/21. The facility reported that on 09/17/21, R1 left the facility (AWOL) unattended and was returned to the facility by staff. Staff were able to redirect the resident back to the community.

On today’s date, LPA and LPM toured the facility and conducted a health and safety check. LPA and LPM briefly spoke to staff, interviewed the Executive Director and requested copies of facility records. No health or safety risks were observed and no deficiencies were cited at this time.

An exit interview was conducted with Jolene Farish, to whom a copy of this report and the LIC9058 Licensee/Appeal Rights were provided via E-mail. An electronic read receipt verifies receipt of these documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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