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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604667
Report Date: 04/18/2024
Date Signed: 04/18/2024 11:19:06 AM

Document Has Been Signed on 04/18/2024 11:19 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MISSION VILLA WESTFACILITY NUMBER:
374604667
ADMINISTRATOR/
DIRECTOR:		ENGDAW, AMSAL D.FACILITY TYPE:
740
ADDRESS:2335 CAMINO DEL RIO SOUTHTELEPHONE:
(619) 501-1244
CITY:SAN DIEGOSTATE: CAZIP CODE:
92108
CAPACITY: 6CENSUS: 5DATE:
04/18/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Teresita YapTIME VISIT/
INSPECTION COMPLETED:
11:31 AM
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Licensing Program Analyst (LPA), Ramon Serrano, conducted an unannounced collateral visit as a follow-up for an unrelated complaint investigation for another facility. LPA was allowed entry by Caregiver Teresita Yap and discussed the purpose of the visit.

During the visit, LPA conducted interviews with resident and staff and obtained facility records.

An exit interview was conducted with Teresita Yap and copy of this report along with Licensee Rights was provided to Teresita Yap whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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