374603399-9-14-2023-18-AS-JSRS-CVP3DJ-20230914180937

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603399
Report Date: 09/14/2023
Date Signed: 09/14/2023 06:09:43 PM

Document Has Been Signed on 09/14/2023 06:09 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	WESTMONT TOWN COURT		FACILITY NUMBER:	374603399
ADMINISTRATOR:	DAVID ALSPACH		FACILITY TYPE:	740
ADDRESS:	500 E VALLEY PKWY		TELEPHONE:	(760) 737-5110
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	200	CENSUS: 140	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Davide Alspach, Executive Director		TIME COMPLETED:	06:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived unannounced to the facility to conduct a required annual inspection. LPA met with Executive Director David Alspach at the front entrance and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. Facility is licensed for 200 non-ambulatory elderly residents; ages 60 and above; 10 of whom may be bedridden. Facility has a hospice waiver for 10 residents. During today's visit, LPA toured the facility inside and out, reviewed records, and interviewed staff, as well as residents. The physical plant was found to be clean, free of odor, and in good repair with no pathway obstruction; facility's temperature measured at 72 degrees; all cleaning solutions were observed in a locked secure area. Staff present have a criminal record clearance in file and are associated to the facility. Tour included: Physical Plant: front entrance, interior and exterior surroundings were observed to be clean with no pathway obstruction; facility's water temperature 115 degrees; all bathrooms were clean and equipped with grab bars. The facility's toilets were observed to be in working order. There is sufficient lightings and mattress pads in all of the residents’ bedrooms. There is also sufficient amount of personal toiletries available for the residents in care. Random smoke detectors were inspected and found to be in working order. LPA inspected the Fire Extinguishers throughout the facility and found them to be in compliance. The indoor swimming pool is available for residents who are not memory care and requires a check out key at the front desk. The facility does not have firearm and/or ammunition on grounds. Continued on LIC 809C

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WESTMONT TOWN COURT	FACILITY NUMBER: 374603399
	VISIT DATE: 09/14/2023

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Continued from LIC 809

Food Services: 7 day non-perishable and 2 day of perishable food supply was observed and all food was properly stored and available to residents.

Items reviewed/discussed: Random staff and residents' records were reviewed. Staff records reviewed have criminal record clearance in file and are properly associated to the facility. Random resident records reviewed have the required documents and are up to date. All required postings were posted near the facility entrance. Administrator certificate expires on 7/23/2025. Last fire drill conducted on 07/28/2023. Facility's medication/PRN logs were reviewed and residents’ medications were inspected for dispensing according to physician’s orders.

No cited deficiencies per Title 22, Division 6 of the California Code of Regulations cited at this time.

An exit interview was conducted and a copy provided to Executive Director David Alspach.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross	TELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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