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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602653
Report Date: 10/08/2021
Date Signed: 10/11/2021 08:16:18 AM

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:AEGIS ASSISTED LIVING AT SHADOWRIDGEFACILITY NUMBER:
374602653
ADMINISTRATOR:LANCE SHENKFACILITY TYPE:
740
ADDRESS:1440 SOUTH MELROSE DRIVETELEPHONE:
(760) 806-3600
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:95CENSUS: 61DATE:
10/08/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Caroline Kilby and Celia LandTIME COMPLETED:
03:20 PM
NARRATIVE
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Licensing Program Analyst, Kristina Ryan, and County of San Diego Nurse HAI Site Assessment Contractors, Elizar Perez and Robert Montillano conducted an on-site visit. The team identified themselves and discussed the purpose of the visit with Wellness Director Caroline Kilby, and Wellness Nurse, Celia Land.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Ms. Kilby and Ms. Land and conducted a walk-through of the facility. A debriefing was conducted with Ms. Kilby and Ms. Land at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Ms. Kilby and Ms. Land and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the administrator via electronic mail. An electronic receipt confirms receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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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