<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603125
Report Date: 04/06/2022
Date Signed: 04/07/2022 09:01:42 AM

Document Has Been Signed on 04/07/2022 09:01 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:RANCHO SANTA FE VILLAFACILITY NUMBER:
374603125
ADMINISTRATOR:BAHA, RAY CYRUSFACILITY TYPE:
740
ADDRESS:8292 RUN OF THE KNOLLSTELEPHONE:
(858) 361-3322
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY: 6CENSUS: 3DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator, Ray Cyrus Baha, Caregiver Weny LabuguinTIME COMPLETED:
10:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 4/6/2022, at 9:35 a.m., Licensing Program Analyst (LPA), Sabel Martinez conducted an unannounced Required 1 - Year Visit. The LPA was greeted by Administrator, Ray Cyrus Baha, and Caregiver, Weny Labuguin. After identifying himself, the LPA was allowed entry and discussed the purpose of the visit.

The LPA observed one central entry point for universal entry screening, routine symptom screening initiated at entry for staff and visitors, and a sign-in policy enacted for all visitors. Signs were posted at facility entrance with the facility’s visitor policy, face coverings were worn by staff, hand sanitizer/hand washing stations were readily available, a designated visitation area, a thirty day supply of Personal Protective Equipment (PPE), and medication supplies were observed. The emergency agencies’ contact information was posted in a location visible to staff and residents. Based on today's observations, the facility is in compliance with and has implemented infection control practices.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of infection control practices. No deficiencies were observed during today's visit.

An exit interview was conducted with Administrator, Ray Cyrus Baha, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via electronic mail. An electronic mail read receipt confirms these documents were received by the Administrator.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1