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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804416
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:32:42 PM

Document Has Been Signed on 04/24/2024 04:32 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/
DIRECTOR:
LABRADOR, VICTORIA N.FACILITY TYPE:
740
ADDRESS:1312 LEAF TERRACETELEPHONE:
(619) 266-2356
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 4DATE:
04/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:55 PM
MET WITH:Victoria Labrador, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit for a Plan of Correction clearance. LPA Lopez identified herself and was allowed entry by caregiver Lydia Cortez. LPA met with Licensee Victoria Labrador and discussed the purpose of the visit.

On 02/14/24, the facility was issued two deficiencies regarding the Administrator Certification and two residents who did not have their updated Physician’s Report (LIC602). During today’s visit, LPA observed that the Administrator had their Certificate on file. LPA also observed that the two residents who needed their LIC602 updated had their updated LIC602 located in their facility file. As such, the deficiencies have been corrected and are deemed cleared.

No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Licensee Victoria Labrador at the conclusion of the visit. The signature below confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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