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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804416
Report Date: 02/14/2024
Date Signed: 02/14/2024 05:07:31 PM

Document Has Been Signed on 02/14/2024 05:07 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VILLA VICTORIA CARE HOMEFACILITY NUMBER:
370804416
ADMINISTRATOR:LABRADOR, VICTORIA N.FACILITY TYPE:
740
ADDRESS:1312 LEAF TERRACETELEPHONE:
(619) 266-2356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 5DATE:
02/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Victoria Labrador, LicenseeTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the facility. LPA Lopez identified herself and was granted entry by caregiver Rosafe Dela Cruz. LPA stated the purpose of the visit and reviewed the basic elements of the visit with licensee Victoria Labrador.

During today’s visit, LPA provided the Licensee consultation and provided additional information regarding the Department’s website, Changes to Administrator Certification Training Requirements (PIN 23-14-CCLD), Criminal Background Clearance Transfer Request (LIC9182) and Criminal Record Exemption Transfer Request (LIC 9188) Form Updates (PIN 23-08-CCLD), Residential Care Facilities for the Elderly Reference Guide to Administrator, Staff, and Volunteer Training Requirements (PIN 23-16-ASC), and Revised Infection Control Regulations and Permanent Adoption (PIN 23-12-ASC).

No deficiencies were observed or cited during this case management visit. An exit interview was conducted with Licensee Labrador and a copy of this report, and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Licensee at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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