374603842-5-22-2024-08-AS-DCOA-D5J7T3-20240522215602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603842
Report Date: 05/22/2024
Date Signed: 05/22/2024 09:56:35 PM

Document Has Been Signed on 05/22/2024 09:56 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:	OCEANSIDE ELDERLY CARE HOME 452		FACILITY NUMBER:	374603842
ADMINISTRATOR:	ALVI, MUHAMMED		FACILITY TYPE:	740
ADDRESS:	452 FOUSSAT RD		TELEPHONE:	7605299257
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY:	6	CENSUS: 3	DATE:	05/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Licensee Muhammed		TIME COMPLETED:	02:55 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), Debbie Correia, made an unannounced visit to conduct the required One-Year Inspection. LPA Correia was greeted by, and introduced herself to, Caregiver Reclusado, then met with Licensee Muhammed and explained the purpose of the visit. The facility is licensed to serve six (6) residents aged 60 and above, all six (6) of whom may be non-ambulatory, three (3) bedridden, and four (4) residents who may be on hospice care. LPA Correia reviewed resident records were reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, and Admission Agreement, and personnel records were reviewed for First Aid/CPR certification, Criminal Record Clearance, TB clearance, and Health Screening Report, and required training. The facility carbon monoxide and smoke alarms were operable. The facilities last disaster drill was conducted on January 18, 2024. LPA Correia, accompanied by Licensee Muhammed, conducted a facility tour, and inspected resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Required postings were observed. Resident bedrooms contained the required furnishings, resident bedrooms either had private or Jack and Jill bathrooms. Resident showers were equipped with non-skid flooring and grab bars. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024

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: OCEANSIDE ELDERLY CARE HOME 452	FACILITY NUMBER: 374603842
	VISIT DATE: 05/22/2024

NARRATIVE

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The facility was equipped with emergency lighting, and first-aid kit and manual. Medications were housed in a locked medication room. Cleaning supplies and other toxins were inaccessible to residents in care. There were no bodies of water on the facility property. Licensee Muhammed there are no firearms or other weapons on the facility premises. The facility had a 7-day supply of non-perishable and a 2-day supply of perishable food. The facility’s ambient internal temperature was compliant, at 74 Fahrenheit. The facility's hot water temperature for faucets used by residents were in compliance.

Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights - LIC 9058 (rev. 01/16) will be provided to Licensee Muhammed, whose signature on this form acknowledges receipt of these documents.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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