374601560-1-29-2024-08-AS-AROS-CZXVJG-20240129152844

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601560
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:28:49 PM

Document Has Been Signed on 01/29/2024 03:28 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:	GLENBROOK ASSISTED LIVING		FACILITY NUMBER:	374601560
ADMINISTRATOR:	HARNESS, SADIE		FACILITY TYPE:	740
ADDRESS:	1950 CALLE BARCELONA		TELEPHONE:	(760) 704-6800
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92009
CAPACITY:	95	CENSUS:	DATE:	01/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sadie Harness, administrator		TIME COMPLETED:	03:30 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 Administrator Sadie Harness, after identifying herself and stating the purpose of the inspection. The facility serves ninety five non-ambulatory elderly residents: ages 60 and above. Hospice care waiver approved for seven. This is a two-story building with approved delayed egress in part of the first floor. LPA was accompanied by Assistant Living Director Kahina Hadibi, 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 food storage areas. There is a fire system in place and the carbon monoxide detectors were operational. The last disaster drill was conducted in December 2023. Exterior and interior passageways were free from obstructions. According to Administrator Harness there are no weapons and/or ammunition stored on the premises. 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: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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: GLENBROOK ASSISTED LIVING	FACILITY NUMBER: 374601560
	VISIT DATE: 01/29/2024

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 room. Medication carts are locked and stored in the wellness medication room, not accessible to residents. 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 interviewed several staff 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.

There are several areas used for activities such daily concerts, exercises, game activities, and arts/crafts. At the time of visit, LPA observed a small group activity, in which some residents were participating. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

No deficiencies were observed or cited at the time of visit.

An exit interview was conducted and a copy of this report and Licensee/Appeal Rights - LIC 9058 (rev. 01/16) were provided to Administrator Harness, 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: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC809 (FAS) - (06/04)

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