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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601952
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:06:10 PM


Document Has Been Signed on 03/20/2024 04:06 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:BROOKDALE OCEANSIDEFACILITY NUMBER:
374601952
ADMINISTRATOR:CHRISTOPHER BURKFACILITY TYPE:
740
ADDRESS:3524 LAKE BLVDTELEPHONE:
7609451811
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:186CENSUS: 88DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Executive Director Candi LairdTIME COMPLETED:
02:29 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Candi Laird.

Today's visit was in response to an LIC624 Incident Report concerning Resident #1 (R1), which Licensee self-submitted to the CCLD San Diego Regional Office (they were received on 03/18/2024) [See LIC 811 Confidential Names List for a description of R1.] Per the reports: On 03/14/2024, Licensee’s staff arranged for R1 to be taken to a local emergency room due to change in their condition. R1 was admitted to hospital and then later moved to a Skilled Nursing Facility.

During today’s visit, LPA performed a brief facility tour and welfare check on the remaining residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed some of the relevant staff.

No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with Executive Director Candi Laird, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy RodgersTELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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