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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881545
Report Date: 02/06/2025
Date Signed: 02/06/2025 11:03:44 AM

Document Has Been Signed on 02/06/2025 11:03 AM - 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:BELLEVUE VILLAFACILITY NUMBER:
371881545
ADMINISTRATOR/
DIRECTOR:		DIZON, CAROLINAFACILITY TYPE:
740
ADDRESS:2080 HEIGHTS COURTTELEPHONE:
(760) 518-8508
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 4DATE:
02/06/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:21 AM
MET WITH:Carolina Dizon, Licensee/applicant TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 02/06/2025 Licensing Program Analyst (LPA) Javina George made an announced visit to the facility to conduct a prelicensing inspection. LPA met with Applicant Carolina Dizon whom accompanied LPA throughout today's inspection. The applicant has applied for a Change of Ownership (CHOW), Residential Care for the Elderly (RCFE), aged 60 and above. On 10/22/24 the Escondido Fire Department approved the facility for (6) non ambulatory residents ,of which no residents can be bedridden. The facility does not have an approved fire clearance to retain bedridden residents.

The facility is single story structure and consists of a garage, backyard with plenty of space to walk and participate in outdoor activities, kitchen, (5) bedrooms and (4) bathrooms. The facility was observed to possess a Solar generator in the event of a power outage. In addition to have the required postings, and operable smoke and carbon monoxide detectors, and (4) fully charged fire extinguishers. The facility was observed to have a sufficient food supply of 2 day of perishable and a 7 day supply of nonperishable food items.
The facility is equipped with non skid mats, grab bars and shower chairs. The resident bedrooms were observed to have adequate lighting, clean linen, chest of drawers, and chairs. The hot water temperature was observed to be within regulatory limits measuring at 108.6-110 degrees Fahrenheit. The medications are being stored inside a locked cabinet inside the kitchen next to the refrigerator. The staff and resident files are locked inside a file cabinet inside the kitchen/common area. There are no pools or bodies of water or known guns or ammunition on the premises. The facility was observed to possess valid liability insurance with an expiration date of 01/06/26.

The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22 Chapter 6, Division 8. The applicant is scheduled to complete COMP III orientation on 02/11/25. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure. An exit interview was conducted and a copy of this report was provided to Carolina Dizon.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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