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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603884
Report Date: 06/04/2020
Date Signed: 06/04/2020 06:01:01 PM

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:RIGHT CHOICE SENIOR LIVING CLAIREMONTFACILITY NUMBER:
374603884
ADMINISTRATOR:TODD BROOKSFACILITY TYPE:
740
ADDRESS:4929 MOUNT LONGSTELEPHONE:
(619) 246-2003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 6DATE:
06/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Todd Brooks, AdministratorTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA), Laarni Santiago, conducted an unannounced Case Management televisit via telephone in regards to an AWOL Incident Report received at the San Diego Regional Office on June 3, 2020. Tele-visit is being conducted due to COVID-19. LPA met with Administrator, Todd Brooks. LPA identified herself and explained the purpose of the televisit.

Today's visit is in response to the AWOL of Resident 1 (R1). Mr. Brooks was provided with a Confidential Names List - 811). Facility staff became aware of R1's absence on May 25, 2020. Subsequently, facility staff reported the absence to the Administrator on the same day. R1 was discovered approximately 2 miles away from the facility. R1 was not observed with any injuries. Local Law Enforcement was eventually initiated after R1 returned to the facility. The Administrator submitted an incident report to CCL on June 3, 2020.

During today's televisit, LPA interviewed administrator, and requested contact information for pertinent witnesses and staff, copies of R1's records, including R1's Absentee Notification Plan, Physician's Report dated 02/10/2020 which indicates the resident is "able to leave the facility unassisted." However, after the incident, R1 was reassessed and determined based on assessment dated 06/03/2020, that R1 is "not fit to leave the facility unassisted." A resident appraisal was requested from Administrator. LPA and Administrator discussed the facility's AWOL and staffing procedures.

No deficiencies were cited during this televisit.

An exit interview was conducted with Mr. Brooks. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to him via email. A read receipt confirmed that these documents have been received by Licensee.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2020
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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