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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603617
Report Date: 08/03/2022
Date Signed: 09/06/2022 08:25:18 AM


Document Has Been Signed on 09/06/2022 08:25 AM - It Cannot Be Edited

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:TORREY PINES SENIOR LIVINGFACILITY NUMBER:
374603617
ADMINISTRATOR:MCDONALD, JASONFACILITY TYPE:
741
ADDRESS:13101 HARTFIELD AVETELEPHONE:
(858) 259-2222
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:125CENSUS: 82DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Sasha Hightower, Executive DirectorTIME COMPLETED:
02:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Jaime Gomez, Concierge. LPA met with Executive Director (ED) Sasha Hightower discussed the purpose of today’s visit. Lizzie Dela Fuente, Health and Wellness Director (HWD), and Abraham Gonzalez, Maintenance Director, jointed the inspection.

A tour of the facility was conducted inside and out. LPA, accompanied by HWD Dela Fuente and Maintenance Director Gonzalez conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing/hand hygiene practices, cough and sneeze etiquette and other infection control procedures; testing plan and procedures for staff and clients; plans for containing infections, PPE supplies procedures and training; and disinfection procedures. LPA provided ED Hightower updated guidance of current PINs for Coronavirus (COVID-19) Updated Diagnostic and Response Testing Guidance for COVID-19 with supplemental guidance; Resident Cohorting, Isolation and Quarantine, Staffing and Use of PPE Based on Resident COVID-19 Status; and Infection Control Plan. LPA spoke with ED Hightower about the submission of the facility’s infection control plan and provided ED with PINs pertinent with updated regulations.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with ED Hightower. A copy of this report, along with the Licensee Rights (01/2016) was provided to ED Hightower at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.

LPA requested for Executive Director Hightower to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms available at www.ccld.ca.gov.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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