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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004831
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:36:45 PM

Document Has Been Signed on 01/28/2025 01:36 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:OCEAN VIEW HOMES, INC.FACILITY NUMBER:
372004831
ADMINISTRATOR/
DIRECTOR:		DIAZ, FEDELIAFACILITY TYPE:
740
ADDRESS:6432 EL CAMINO DEL TEATROTELEPHONE:
(858) 459-9260
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 6CENSUS: 5DATE:
01/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Facility Manager Alicia MillanTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself and disclosed the purpose of the visit to Facility Manager Alicia Millan. The facility was licensed for a capacity of six (6) non-ambulatory residents, and had an approved hospice waiver for three (3) residents.

Accompanied by Millan, the LPA toured the interior and exterior of the facility, and inspected bedrooms. The facility
was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens
and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

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

No pools, nor bodies of water were observed on the premises. Per staff, no firearms, nor ammunition were kept at the facility. A carbon monoxide detector, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were also present. Required licensing postings were observed in visible areas of the facility.

The LPA conducted an interview and reviewed multiple staff and resident files. A deficiency for missing staff health screenings was cited in an LIC 809D form. A Plan of Correction (POC) was jointly formulated with Facility Manager Alicia Millan.

An exit interview was conducted with Millan, to whom a copy of this report, LIC 809D, LIC 811, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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Document Has Been Signed on 01/28/2025 01:36 PM - It Cannot Be Edited


Created By: Sabel Martinez On 01/28/2025 at 01:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OCEAN VIEW HOMES, INC.
FACILITY NUMBER: 372004831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)(11)
87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review of records and interview, the licensee did not comply with the section cited above in 3 of 5 staff (S1, S3, and S4), which poses/posed a potential health, safety or personal rights risk to all persons in care.
POC Due Date: 02/04/2025
Plan of Correction
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Facility manager agreed to obtain health screenings for S1, S3, and S4, and submit them to the LPA by 2/4/25.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Sabel Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


LIC809 (FAS) - (06/04)
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