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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604421
Report Date: 08/23/2024
Date Signed: 08/23/2024 12:57:29 PM

Document Has Been Signed on 08/23/2024 12:57 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:LA JOLLA VISTAFACILITY NUMBER:
374604421
ADMINISTRATOR/
DIRECTOR:
FERNANDEZ, GUSFACILITY TYPE:
740
ADDRESS:5720 DESERT VIEW DRTELEPHONE:
(858) 775-6935
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 6CENSUS: 3DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Administrator Jennifer FernandezTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself and disclosed the purpose to Caregiver Kathia Badilla. Administrator Jennifer Fernandez arrived during the visit an assisted the LPA. The facility was licensed for a capacity of six (6) non-ambulatory residents, of which one (1) may be bedridden in bedroom # 2. The facility also had a hospice waiver approved for two (2) residents.


The LPA, accompanied by administrator, toured the interior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, and stored in a locked area.



No pools, nor bodies of water on the premises. Per staff, no firearms, nor ammunition were kept at the facility. Carbon monoxide detectors, fire extinguisher(s) and a First aid kit(s) were present. Required licensing postings were observed in visible area of the facility.

The LPA interviewed staff and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents. Technical advise was provided, and no deficiencies were cited during today's annual inspection.

An exit interview was conducted with Administrator Jennifer Fernandez, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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