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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604451
Report Date: 06/28/2024
Date Signed: 06/28/2024 01:31:37 PM


Document Has Been Signed on 06/28/2024 01:31 PM - 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:ALTA VIEW MANORFACILITY NUMBER:
374604451
ADMINISTRATOR:AUSTRIA, VIRNA LIZA R.FACILITY TYPE:
740
ADDRESS:1727 TOBACCO ROADTELEPHONE:
(858) 705-9696
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:6CENSUS: 5DATE:
06/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator, Virna AustriaTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Virna Austria, who was informed of the purpose of the visit. At the time of the visit there was (3) staff present, and (5) residents present.

The facility is a two story home with (5) bedrooms and (3) bathrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility exceeded the required 2-day supply of perishable and 7-day supply of non-perishable foods. The facility retains an emergency and disaster plan and emergency supplies. LPA reviewed documentation showing the facility's last fire drill 6/2/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions.

LPA reviewed (4) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. (2) client files were reviewed, and possessed all required paperwork. Client medications review and accounted for on MARS log. No deficiencies were cited at the time of the visit. An exit interview was conducted were this report was reviewed and provided.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024
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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