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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604042
Report Date: 07/11/2024
Date Signed: 07/11/2024 02:44:15 PM

Document Has Been Signed on 07/11/2024 02:44 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HIDDEN GLENN SENIOR LIVING IFACILITY NUMBER:
374604042
ADMINISTRATOR/
DIRECTOR:		LOFVENDAHL, BRIGITTA MFACILITY TYPE:
740
ADDRESS:612 TRANQUILITY GLENTELEPHONE:
(760) 743-8843
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 15CENSUS: 11DATE:
07/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Executive Director,Brigitta LofvendahlTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On today's date 07/11/24 at 10:00am Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit/annual inspection. LPA met with Executive Director Brigitta Lofvendahl and explained the purpose of the visit. At the time of the inspection there were 4 staff and 11 residents present. The facility is licensed to serve residents age 60 and over, 15 non ambulatory of which 15 may be bedridden. The facility has an approved hospice waiver for six (6). There is currently one (1) resident receiving hospice services. Below are the observations made during today's visit:
The facility is a single story structure with 7 combined bedrooms and bathrooms, dining area, front and back patio, kitchen, living room, activities room, medication closet, and garage which is used to store the laundry appliances, generator and extra food. The facility was observed to be clean and clutter and odor free. The call lights were tested and observed to be operable. LPA observed all toxic chemicals and other hazards/sharps to be inaccessible to residents. The medications are locked inside the mediation closet, that is accessed via a key pad.

The facility food supply met the requirements of a 2 day supply of perishable and a 7 day supply of non perishable food items. There were expired canned goods, that were discarded at the time of LPAs visit, therefore no citations will be issued.

Staff present were observed to have obtained criminal record clearance and to be associated to the facility. Staff present were observed to have current CPR/First Aid training, and possess a valid Administrator certificate which expires on 04/16/2025. Resident files were observed to have the required documentation such as physician's report, appraisal, and admissions agreement.

The hot water temperature was tested and found to be within regulatory limits, measuring at 107.9 degrees Fahrenheit. The facility has (2) fully charged fire extinguishers fully charged. The emergency drills are conducted quarterly, the last drill was conducted on 4/16/24.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HIDDEN GLENN SENIOR LIVING I
FACILITY NUMBER: 374604042
VISIT DATE: 07/11/2024
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The last fire inspection was conducted on 12/14/23. The smoke and carbon monoxide detectors were tested and found to be operable.

Based on today's inspection, no deficiencies were observed during today's visit. The facility was found to be in compliance with California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of the report and LIC 811 confidential names list was provided to the Executive Director,Brigitta Lofvendahl .
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024
LIC809 (FAS) - (06/04)
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