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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604476
Report Date: 01/05/2024
Date Signed: 01/05/2024 12:33:15 PM

Document Has Been Signed on 01/05/2024 12:33 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NEW VISION HOMES ARFFACILITY NUMBER:
374604476
ADMINISTRATOR:BELTRAN, YESENIAFACILITY TYPE:
735
ADDRESS:859 LACEBARK STTELEPHONE:
(442) 515-3083
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 4CENSUS: 3DATE:
01/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:ADMINISTRATOR, YESENIA BELTRANTIME COMPLETED:
12:38 PM
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On January 05, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the listed facility unannounced to conduct the required annual and met with Administrator, Yesenia Beltran. LPA Mixson introduced herself and stated the purpose of the visit. The facility file review was conducted in the office and additional forms were request and received at the facility.

LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 859 Lacebark St, San Marcos, CA. 92069. Physical Plant: The facility phone number is (442)515-3083 and is operable. The LPA observed the residents bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected two facility bathrooms, and the hot water temperature was tested and tested within regulations in both, and logged by the Administrator on facility log. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as the "Personal Rights" the "Ombudsman" and the Community Care Licensee postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files they were locked and inaccessible to residents in care. Medications: the medications were reviewed and were locked and inaccessible to residents, and had a 30 day supply. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply are sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, two staff currently at time of this visit, and engaging the residents in activities. Records Review: LPA Mixson reviewed three resident files, and two staff files, and conducted two staff interviews, and two resident interviews, one resident is at the Day Program. Previous CCLD forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit.
An exit interview was conducted and a copy of this report was given to the Administrator, Yesenia Beltran.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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