374600619-1-16-2024-08-AS-AROS-CZJTMA-20240116135048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600619
Report Date: 01/16/2024
Date Signed: 01/16/2024 01:51:12 PM

Document Has Been Signed on 01/16/2024 01:51 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:	LEICHTAG FAMILY ASSISTED LIVING RESIDENCE		FACILITY NUMBER:	374600619
ADMINISTRATOR:	CARL MEASER		FACILITY TYPE:	740
ADDRESS:	211 SAXONY ROAD		TELEPHONE:	(760) 632-0081
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	77	CENSUS: 68	DATE:	01/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Executive Director Carl Maser		TIME COMPLETED:	01:25 PM

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	Licensing Program Analyst (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection. LPA Rodgers was granted entry into the facility by Executive Director Carl Measer, after identifying herself and stating the purpose of the inspection. The facility serves 77 non-ambulatory elderly residents, age 60 and above, of which 9 may be bedridden in Building E. rooms 1-9. There is an approved Hospice Waiver for 20 residents LPA was accompanied by Mary Fawell Director of Leichtag Family Assisted Living Residence as well as David Pinto Director of the Katzin Residence, during a tour of the facility, which was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and satellite kitchen areas. There is a fire signal system in place and the carbon monoxide detectors were operational. The last disaster drill was conducted on December 2023. Exterior and interior passageways were free from obstructions. According to Executive Director Measer, there are no weapons and/or ammunition stored on the premises. Pull cords, restless pads, and sensor lights were present in Building E. Pull cords and remote call buttons were present in Building D. LPA Rodgers observed functionality of signal system. Resident's room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens, towels, and washcloths. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. [Continued on 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

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: LEICHTAG FAMILY ASSISTED LIVING RESIDENCE	FACILITY NUMBER: 374600619
	VISIT DATE: 01/16/2024

NARRATIVE

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[Continued on 809]

Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closet. Medication rooms are in both building E and D. The medication carts were locked and are located in each medication room. Medications were labeled and kept in compliance with label instructions.

LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained all required documents. LPA Rodgers also conducted a review of In-service training procedures. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 01/16) were provided to the Executive Director Measer, whose signature on this form acknowledges receipt of these documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC809 (FAS) - (06/04)

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