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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601952
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:28:16 AM


Document Has Been Signed on 08/11/2022 11:28 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:BROOKDALE OCEANSIDEFACILITY NUMBER:
374601952
ADMINISTRATOR:MANADI, FOUDHILFACILITY TYPE:
740
ADDRESS:3524 LAKE BLVDTELEPHONE:
(760) 945-1811
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:186CENSUS: 98DATE:
08/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Foundil ManadiTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to follow up on an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit to Executive Director Foundil Manadi and Business Office Director Candi Laird.

The Department received an incident report from the facility on 8/11/2022 stating the Resident 1 (R1) had eloped from the facility on 8/6/22. [Executive Director was provided with an LIC811 Confidential Names list to identify R1].

During today's visit, LPA toured the facility, interviewed staff, and reviewed and obtained copies of facility records.

No deficiencies were cited or observed on this date. An exit interview was conducted with Executive Director Foundil Manadi, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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