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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881376
Report Date: 02/19/2025
Date Signed: 02/19/2025 12:53:32 PM

Document Has Been Signed on 02/19/2025 12:53 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:ESCONDIDO RETIREMENT GARDENFACILITY NUMBER:
371881376
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, MERCELITAFACILITY TYPE:
740
ADDRESS:819 N. ROSE STREETTELEPHONE:
(760) 294-4433
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 4DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Mercelita Williams, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 02/19/25 at 10:50am Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA met with Administrator Mercilita Williams where LPA explained the purpose of the visit. At the time of the visit there was (2) staff and (3) residents present. The facility is licensed to serve age range 60 and over (3) ambulatory and (3) non ambulatory, of which (1) may be bedridden. The facility has an approved hospice waiver for (3), with (2) residents currently receiving hospice services.
LPA conducted a tour of the interior and exterior areas of the facility. The no pools or bodies of water on the premises, or known guns and ammunition. The facility has (2) fully charged fire extinguishers that were just services 01/27/25. The facility was observed to utilize video surveillance on the exterior of the property and inside the kitchen and in the hallway facing the medication cart. The facility is conducting (2) emergency disaster drills on a quarterly basis. The last drills were conducted on 01/10/25-power failure and 01/17/25-fire drill. The sharps and chemicals were observed to be locked and inaccessible to residents in care. The smoke and carbon monoxide detectors were observed to be operable. The facility was observed to have valid liability insurance that expires 06/07/25. The facility does not utilize a Medication Authorization Record, but was observed to be utilizing the centrally stored form. The medication were observed to be locked inside a medication cart.

File review the facility has (2) respite residents and (2) long term residents, both long term residents are receiving hospice services. The files were observed to have medical assessments, admissions agreements. The staff were observed to have obtained criminal record clearance and to be associated to the facility. In addition staff were observed to have valid CPR certification that expires 02/2026. The administrator Mercilita Williams was observed to have a valid administrator certificate that expires on 06/28/26.
The facility was observed to have an adequate food supply of a 2 day supply of perishable and a 7 day supply of non perishable food items. Based on today's inspection there were no deficiencies issued.
An exit interview was conducted and a copy of this report was provided to administrator Mercilita Williams.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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