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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601952
Report Date: 05/22/2019
Date Signed: 10/05/2021 12:02:34 PM

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:BROOKDALE OCEANSIDEFACILITY NUMBER:
374601952
ADMINISTRATOR:ECKERT, LAURAFACILITY TYPE:
740
ADDRESS:3524 LAKE BLVDTELEPHONE:
(760) 945-1811
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:186CENSUS: 89DATE:
05/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Laura Eckert, AdministratorTIME COMPLETED:
11:25 AM
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This is an amended report, dated 10/5/21. The original report was created on 5/22/19.

Licensing Program Analyst (LPA), Jonathan Pineda made an unannounced visit to conduct a case management visit regarding an unusual incident report submitted to CCL on 5/7/19 by the licensee. LPA identified himself and was granted entry into the facility by Laura Eckert, Administrator

It was reported that on May 8, 2019, resident (R1) was found lying on his back on the floor next to his bed. Resident was evaluated and sent to Tri City Medical Center by ambulance where R1 was diagnosed with a hip fracture. Based on observation, interviews, and record review, LPA did not observe any culpability.

No deficiencies were cited during today’s visit.

This report was discussed and a copy along with Licensee Rights (01/16) was provided to Laura Eckert.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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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