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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603513
Report Date: 08/17/2021
Date Signed: 08/17/2021 03:47:22 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:PARKWAY GARDENS RETIREMENT CARE HOMEFACILITY NUMBER:
374603513
ADMINISTRATOR:CARMINDA RAMIREZFACILITY TYPE:
740
ADDRESS:660 VAN HOUTEN AVETELEPHONE:
(619) 444-2729
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:15CENSUS: 14DATE:
08/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:House Manager, Kyle "Casey" HernandezTIME COMPLETED:
03:46 PM
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Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced Case Management inspection regarding an Absence Without Leave (AWOL) incident received at the San Diego Office on August 16, 2021. LPA was allowed entry into the facility byCaregiver, Arthuro Vinarao, after identifying himself. LPA met with House Manager, Casey Hernandez, and explained the purpose of the inspection.

During today’s inspection, LPA briefly toured the facility, collected records, and interviewed staff and residents.

It was reported that Resident #1 (R1, see List of Confidential Names) left the facility for a doctor’s appointment on August 12, 2021 and has not returned to the facility. At this time, this incident requires further review and additional information is needed. No deficiencies were cited during this visit.

An exit interview was conducted with the House Manager. A copy of this report and Licensee’s Rights (9058 01/16) were provided to the Administrator, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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