374603182-1-25-2024-08-AS-AROS-CZU2R7-20240125163703

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603182
Report Date: 01/24/2024
Date Signed: 01/25/2024 04:37:29 PM

Document Has Been Signed on 01/25/2024 04:37 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:	RAMONA SENIOR MANOR		FACILITY NUMBER:	374603182
ADMINISTRATOR:	GALANG, MARJORIE C.		FACILITY TYPE:	740
ADDRESS:	1236 D STREET		TELEPHONE:	(760) 440-9844
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	28	CENSUS: 23	DATE:	01/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Marjorie Galang, Administrator		TIME COMPLETED:	01:00 PM

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Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Marjorie Galang, Administrator, after identifying herself and stating the purpose of the inspection. This facility serves twenty-eight residents, ages 60 and above; of which all are non-ambulatory. Nine (9) of whom may be bedridden on the first floor. Approved for hospice for fourteen residents. Facility is equipped with a secured perimeter.

A tour of the facility was conducted which included a sample of resident units, the dining area, common gathering areas, and food storage areas. There are no water features on site. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with the required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Showers were equipped with grab bars and non-slip mats. Hot water temperature in residents’ bathrooms were compliant.

The facility is operating in accordance with their fire clearance. The smoke and carbon monoxide alarms were present in the building. Emergency lighting, and facility telephone were all working. First aid kit(s) were complete and readily accessible in the medical rooms. Required licensing postings were observed in visible areas of the facility. PPE supplies are onsite. Passageways were free from obstructions.

Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items.Food supply is replenished frequently by staff. Food was observed to be properly labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Centrally stored medications were properly stored and locked in a medication room.

[CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RAMONA SENIOR MANOR	FACILITY NUMBER: 374603182
	VISIT DATE: 01/24/2024

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[CONTINUED FROM LIC 809]

Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPAs conducted a review of In-service training procedures. LPA interviewed Administrator Galang and was assured transportation procedures as well as outside medical and dental assistance procedure are compliant.

There is a large common room used for dining and activities such daily exercises, game activities, and arts/crafts.. At the time of visit, LPA observed a large group activity, in which many residents were participating. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

No deficiencies were issued at the time of visit; however, technical violations were issued at today’s visit.

An exit interview was conducted with Administrator Galang to whom copies of this report, Licensee/Appeal Rights (LIC9058 03/22), LIC9102’s was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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