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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600872
Report Date: 04/06/2022
Date Signed: 04/07/2022 11:30:03 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/07/2022 11:30 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
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: 6DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Caregiver, Jerome OsitTIME COMPLETED:
05:30 PM
NARRATIVE
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On 4/6/2022, at 2:41 p.m., Licensing Program Analyst (LPA), Sabel Martinez, visited the facility to conduct an unannounced Required - 1 year visit. The LPA was greeted by Caregiver, Jerome Osit, introduced himself, and discussed the purpose of the visit.

During today's visit, the LPA toured the facility, and verified compliance with infection control practices. The LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; and emergency agencies’ contact information posted in a location visible to staff and residents.

The LPA and Caregiver observed centrally stored medication to be unlocked and accessible to residents in care. Per Title 22, California Code of Regulations, this deficiency was cited in an LIC 809D.

An exit interview was conducted with Caregiver, Jerome Osit. A copy of this report, along with the Licensee Rights (LIC 9058 FAS 01/16) were provided to the Administrator, Alicia Millan, via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
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 04/07/2022 11:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 III
FACILITY NUMBER: 374600872

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/06/2022
Section Cited

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87465(h)(2)Incidental and Medical Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
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Based on observation and interview, the facility staff did not not lock centrally store medicaiton which poses an immediate health, Safety, and Personal Rights risk to five out of six persons in care.
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Adminitrator will train all staff on how to properly store and lock medication. Confirmation and log of completed training will be submitted tot he LPA by 4/27/22.

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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: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
LIC809 (FAS) - (06/04)
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