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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603201
Report Date: 03/05/2021
Date Signed: 03/08/2021 07:37:30 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:PARKVIEW GARDENSFACILITY NUMBER:
374603201
ADMINISTRATOR:WERY, MARKFACILITY TYPE:
740
ADDRESS:14203 MIDLAND ROADTELEPHONE:
(858) 335-0916
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
03/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Terri WeryTIME COMPLETED:
03:40 PM
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Licensing Program Manager (LPM), Simon Jacob, County of San Diego Nurse Contractors Sandra Brackman and Jeffrey Meilander ; California Department Public Health (CDPH), Health Facility Evaluator Nurse (HFEN), Hosniyeh Bagheri with the HAI Program, conducted an on-site visit. LPM and team identified themselves and discussed the purpose of the visit with LIcensee Terri Wery, Administrator Everette Wery and Lead Caregiver Mirtha Oropeza.

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

During today's visit, no deficiencies were issued. An exit interview was conducted with Ms. Terri 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 of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Kimberly LyonTELEPHONE: (619) 767-2300
LICENSING EVALUATOR NAME: Simon JacobTELEPHONE: (619) 767-2306)
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021
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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