<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600619
Report Date: 07/16/2024
Date Signed: 07/16/2024 11:23:24 AM


Document Has Been Signed on 07/16/2024 11:23 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:LEICHTAG FAMILY ASSISTED LIVING RESIDENCEFACILITY NUMBER:
374600619
ADMINISTRATOR:CARL MEASERFACILITY TYPE:
740
ADDRESS:211 SAXONY ROADTELEPHONE:
(760) 632-0081
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:77CENSUS: 67DATE:
07/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Director Mary FawellTIME COMPLETED:
11:35 AM
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) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Director Mary Fawell, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident of a staff member allegedly speaking to a resident in a disrespectful manner.

LPA interviewed staff and residents and collected records. A wellness check was completed; no health or safety issues were identified.  No deficiencies were cited or observed on this date. 

An exit interview was conducted with Director Mary Fawell, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Their signature confirms receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1