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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 07/10/2024
Date Signed: 07/10/2024 11:38:29 AM


Document Has Been Signed on 07/10/2024 11:38 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
SAN DIEGO RO, 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:78CENSUS: DATE:
07/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Resident Care Director Nae BrownellTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Ryan Fulton conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Resident Services Director Nae Brownell , and we discussed the purpose of the visit.

Community Care Licensing received an incident report on 7/09/24 in which it was reported that Resident #1 (R1) went absent without official leave (AWOL) from the facility on 7/06/24. R1 left the community at approximately 11:18 am via GoGo Driver and returned to facility at approximately 12:24 pm. Per records reviewed licensee followed absentee notification plan as necessary.

During today's visit, LPA conducted a health and safety check of the residents in care and provided consultation. LPA Fulton observed auditory alarm installed in the memory care cottage. No deficiencies were cited during today’s visit.

An exit interview was conducted with Resident Service Director Nae Brownell who was also provided a copy of their appeal rights (LIC9058 03/22), LIC811, this report and their signature on this form, acknowledges receipt of these rights
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -76-2311
LICENSING EVALUATOR NAME: Ryan FultonTELEPHONE: 619-629-8938
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024
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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