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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603356
Report Date: 08/10/2021
Date Signed: 08/10/2021 05:57:59 PM

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:RAMONA SENIOR LODGE ASSISTED LIVINGFACILITY NUMBER:
374603356
ADMINISTRATOR:SERENA NELSONFACILITY TYPE:
740
ADDRESS:15855 MARMAC DRIVETELEPHONE:
(760) 440-0168
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:6CENSUS: 6DATE:
08/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Joy Mendoza, StaffTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility and met with Joy Mendoza, Staff, with whom she discussed the purpose of the visit.

During today's visit, LPA toured the facility, provided consultation and guidance, and verified compliance with infection control practices. LPA and Joy Mendoza reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation. LPA observed one central entry point for universal entry screening; supplies to conduct routine symptom screening at entry; a sign-in policy enacted for visitors; signs posted at facility entrance with the facility’s visitor policy, and signs in the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; available visitation areas; emergency agencies’ contact information visible to staff; and an adequate supply of cleaning products.

No deficiencies were cited during today’s visit. An exit interview was conducted with Joy Mendoza, Staff, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) were provided to Serena Nelson, Licensee, via email, following the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

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

DATE: 08/10/2021
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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