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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601046
Report Date: 12/15/2023
Date Signed: 12/15/2023 11:11:23 AM


Document Has Been Signed on 12/15/2023 11:11 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:BROOKDALE PLACE OF SAN MARCOSFACILITY NUMBER:
374601046
ADMINISTRATOR:PRESTON, MARIOFACILITY TYPE:
740
ADDRESS:1590 W SAN MARCOS BLVDTELEPHONE:
(760) 471-9904
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:245CENSUS: 1DATE:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:ADMINISTRATOR, MARIO PRESTONTIME COMPLETED:
11:18 AM
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On December 15, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Administrator, Mario Preston. The facility file was reviewed prior to the visit. All staff present have a current criminal record clearance.

LPA Mixson introduced herself and toured the facility along with the Administrator. The facility was inspected inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility licensed to serve 245 elderly residents, but is currently operating at 153. The facility is a double level building, located at 1590 W. San Marcos BLVD San Marcos, CA. 92078. Physical Plant: The facility phone number is (760) 471-9904 and is operable. The LPA observed a sample of the residents living units, and they are equipped with required furniture as per Title 22. The LPA inspected a sample of the facility restrooms, and the hot water temperature was tested and tested within regulations. The restrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something," the "Personal Rights," and the Ombudsman's postings were posted in a common area. The cleaning supplies and sharp items were locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files it was locked and inaccessible to residents in care. Medications: The nurses station had an area designated for medications and it was locked and inaccessible to residents. The overall facility is clean, the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff. Staff and residents were occupied with the morning meal, and other activities. Records Review: The LPA reviewed six resident files, and five staff files, and conducted staff and resident interviews. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Administrator, Mario Preston.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2023
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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