<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603509
Report Date: 05/15/2024
Date Signed: 05/21/2024 04:27:07 PM


Document Has Been Signed on 05/21/2024 04:27 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:WESTMONT AT SAN MIGUEL RANCHFACILITY NUMBER:
374603509
ADMINISTRATOR:MICHAEL SOKOLOWSKIFACILITY TYPE:
740
ADDRESS:2325 PROCTOR VALLEY RDTELEPHONE:
(619) 271-4385
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY:105CENSUS: 76DATE:
05/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director Jessica Zepeda and Maintenance Director George Hayes TIME COMPLETED:
12:30 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) conducted an unannounced Case Management visit. LPA disclosed the purpose the visit to Mainentance Director George Hayes and was allowed entry into the facility. Executive Director Jessica Zepeda met with LPA shortly after.

The facility presently uses delayed-egress doors in its secured memory care area and requested the local fire authority to grant approval in writing for the use of the delayed-egress doors. The Fire Safety Inspection Request (STD850) was completed by the local fire authority and received in the RO on May 9, 2024. The requested fire clearance has been approved by the local fire marshal, which includes the facility's updated floor plan and the use of delayed egress.

LPA reviewed the facility’s updated floor plan, which matches the STD850. LPA also observed that the new floor plan was posted in a visible area.

No deficiencies were observed or cited during today's visit. An exit interview was conducted with Jessica Zepda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1