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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 11/09/2023
Date Signed: 11/09/2023 11:18:52 AM


Document Has Been Signed on 11/09/2023 11:18 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:HERITAGE HILLSFACILITY NUMBER:
374603778
ADMINISTRATOR:STEFANIE ANCHETAFACILITY TYPE:
740
ADDRESS:2108 EL CAMINO REALTELEPHONE:
(760) 206-7930
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:74CENSUS: 71DATE:
11/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Culinary Director Steven EnnisTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Culinary Director Seven Ennis.

On 07/10/2023, the Licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) requesting to increase the facility's total licensed capacity from seventy four (74) residents up to seventy-eight (78) residents. The facility’s floor plan remained unchanged.



On 09/15/2023, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for seventy-eight (78) residents in total, of which up to sixty-eight (68) may be non-ambulatory and up to ten (10) may be bedridden.

During today’s visit, LPA briefly toured the interior and exterior of the facility. LPA also inspected the four bedrooms (i.e., Rooms #205, #210, #212, and #215) which Licensee intends to turn from private to shared, finding that each of these bedrooms had sufficient space to comfortably house two residents and their required furnishings. The facility sketch/floor plan was consistent with the current layout of the facility.

No deficiencies were observed or cited during today's visit.

This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval.

An exit interview was conducted with Ennis, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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