374603724-1-9-2024-08-AS-AROS-CZC34F-20240109165503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603724
Report Date: 01/09/2024
Date Signed: 01/09/2024 04:55:08 PM

Document Has Been Signed on 01/09/2024 04:55 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:	MONARCH COTTAGES LA JOLLA		FACILITY NUMBER:	374603724
ADMINISTRATOR:	RISA BISHOP		FACILITY TYPE:	740
ADDRESS:	7630 FAY AVENUE		TELEPHONE:	(858) 924-8530
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	52	CENSUS: 27	DATE:	01/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Director Risa Bishop		TIME COMPLETED:	05:05 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) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Director Risa Bishop, after identifying herself and stating the purpose of the inspection. The facility serves 52 non-ambulatory residents, age 60 and above, of which 8 may be bedridden. There is an approved Hospice Waiver for 12 residents. This is a two-story complex, equipped with delayed egress and secured perimeters. LPA was accompanied Director Bishop during a tour of the facility. Tour was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. The last disaster drill was conducted on December 21, 2023. No bodies of water are on premises. Passageways were free from obstructions. According to Director Bishop, there are no weapons and/or ammunition stored on the premises. Signal Systems was available in each resident unit and LPA observed functionality of said system. Delayed Egress and secured perimeter doors were also tested for functionality. Resident's room temperatures were within a comfortable range. Each resident had clean and sufficient bed linens. All extra linens, towels, and washcloth inventory was kept in each resident’s room. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MONARCH COTTAGES LA JOLLA	FACILITY NUMBER: 374603724
	VISIT DATE: 01/09/2024

NARRATIVE

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[CONTINUED FROM LIC 809]

Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closet and outside storage area. The medication room is secured and has a locked medication cart, emergency supplies, and medications were labeled and kept in compliance with label instructions.

Staff records review verified that all staff records were complete and compliant. Staff records review verified that all staff have a current First Aid certificate and at least one staff member, per shift, has a First Aide/CPR certificate. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPA conducted a review of In-service training procedures. LPA interviews with Director Bishop confirm residences are provided with assistance necessary for medical and dental appointments. LPA reviewed the theft and loss policy and procedures.

No deficiencies were cited at the time of visit. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

An exit interview was conducted, this report was discussed with Director Bishop, a copy along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the Director Bishop.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC809 (FAS) - (06/04)

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