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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603509
Report Date: 10/27/2020
Date Signed: 10/27/2020 06:50:56 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:WESTMONT AT SAN MIGUEL RANCHFACILITY NUMBER:
374603509
ADMINISTRATOR:NEWTON, RANDALFACILITY TYPE:
740
ADDRESS:2325 PROCTOR VALLEY RDTELEPHONE:
(619) 271-4385
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY:126CENSUS: 86DATE:
10/27/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Randal NewtonTIME COMPLETED:
01:00 PM
NARRATIVE
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Regional Manager (RM), Icela Estrada; Licensing Program Manager, Rebecca Hedgecock, County of San Diego Nurse Contractors, Jennifer West, and Sandra Brackman; California Department Public Health (CDPH), Health Facility Evaluator Nurse (HFEN), Denise Elliott and Zenith Kihwaja with the HAI Program, conducted an on-site visit. RM and team identified themselves and discussed the purpose of the visit with Executive Director, Randal Newton and Charito Quiocho Doles, Daniel Sansano, and Jennifer Zelaya.
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 Mr. Newton and conducted a walk-though of the facility. A debriefing was conducted with Mr. Newton at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with the Executive Director, Randal Newton and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to him via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Rebecca HedgecockTELEPHONE: (619) 241-0535
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020
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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