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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601952
Report Date: 04/15/2024
Date Signed: 04/15/2024 12:10:24 PM


Document Has Been Signed on 04/15/2024 12:10 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:
(760) 945-1811
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:186CENSUS: 87DATE:
04/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Executive Director Candi LairdTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Candi Laird.

This visit was initiated due to an incident report that was self reported by the facility to the Department on 4/12/2024. The incident report narrative described that sometime in April 2024, Resident 1 (R1) had reported to an outside source that an altercation between R1 and an unknown individual had occurred. The described altercation did not result in any injuries. The facility became aware of the alleged altercation when the outside source reported R1's statement to the facility management. The facility followed required reporting requirements to the Department and Long Term Care Ombudsman.

During today’s visit, LPA toured the facility, observed residents in care, conducted a health and safety check, and reviewed and obtained copies of facility records. No immediate health or safety concerns were observed during the facility tour.

No deficiencies were cited during today’s visit. An exit interview was conducted with Executive Director Candi Laird, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
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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