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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600872
Report Date: 07/02/2020
Date Signed: 07/03/2020 08:39:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OCEAN VIEW HOMES IIIFACILITY NUMBER:
374600872
ADMINISTRATOR:ALICIA MILLANFACILITY TYPE:
740
ADDRESS:6602 AVENIDA MIROLATELEPHONE:
(858) 551-2736
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:6CENSUS: 4DATE:
07/02/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Alice Millan, AdministratorTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Laarni Santiago conducted a Tele-Virtual Visit due to COVID-19. LPA identified herself to the Administrator, Alicia Millan, and we discussed the purpose of the visit.

Today's visit is in response to the AWOL of Resident 1 (R1 - see LIC811 Confidential Names List), date of incident: June 27, 2020. The facility properly reported R1 missing to CCLD, timely. Interviews corroborate that R1 was last observed in the common area at approximately 5:45PM. At around 6PM, staff discovered that R1 were not in their usual chair, therefore, they started looking for R1 throughout in and out of the facility premises. Staff left the facility to scope the neighborhood and in less then 15 minutes discovered R1 in a nearby school district surrounded by ambulance and law enforcement. Based on interviews, the facility's neighbor initiated 9-1-1 after observing R1 fall. Records and interviews revealed that R1 is unable to leave the facility unassisted but does not have a history of wandering. The facility's Absentee Notification Plan was reviewed on this date which the facility followed. R1 subsequently returned to the facility upon discharge from the hospital. LPA attempted to conduct an interview with R1 on this date, and they presented with no signs of injury, and follow up has already been scheduled with their PCP for the change of condition. Resident Appraisal and updated care plan were requested from Administrator.
No deficiencies were cited or observed on this date.

An exit interview was conducted with the Administrator, Alicia Millan. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Alicia via email and an electronic read receipt verifies receipt of this document.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2020
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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