370800394-4-30-2024-08-AS-THOS-D4TUQ4-20240430154630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370800394
Report Date: 04/30/2024
Date Signed: 04/30/2024 03:47:12 PM

Document Has Been Signed on 04/30/2024 03:47 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:	COVENANT LIVING AT MOUNT MIGUEL		FACILITY NUMBER:	370800394
ADMINISTRATOR:	RICHARD MILLER		FACILITY TYPE:	741
ADDRESS:	325 KEMPTON STREET		TELEPHONE:	(619) 479-4790
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY: 435		CENSUS: 354	DATE:	04/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ron Alamario, Administrator		TIME COMPLETED:	01:12 PM

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Ron Alamario, Administrator.

According to the facility’s license, the facility has a maximum capacity of four hundred and thirty five (435) residents. During today’s inspection, there were a total of three hundred and fifty four (354) residents in care.

LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected twenty seven (27) rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident rooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant: Bathroom sinks ranged from 105.2 F - 120 F.

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 sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: COVENANT LIVING AT MOUNT MIGUEL	FACILITY NUMBER: 370800394
	VISIT DATE: 04/30/2024

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[CONTINUED FROM LIC 809]

There is a pool and jacuzzi on the premises that is gated and locked. Per staff, there are firearms or ammunition that are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and residents and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Ron Alamario, Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

LIC809 (FAS) - (06/04)

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