<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604060
Report Date: 01/03/2022
Date Signed: 01/03/2022 08:31:28 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:GROSSMONT GARDENSFACILITY NUMBER:
374604060
ADMINISTRATOR:KAITLIN RUDOLPHFACILITY TYPE:
740
ADDRESS:5480 MARENGO AVETELEPHONE:
(619) 463-0281
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:425CENSUS: 182DATE:
01/03/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Associate Executive Director Lane Hermosillo and Resident Service Director Shirley JonesTIME COMPLETED:
03:00 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) Dang Nguyen conducted an announced Case Management visit, accompanied by nurse contractors Elizar Perez and Sandra Brackman from the Healthcare Associated Infection (HAI) team of San Diego County Health and Human Services Agency. LPA and HAI nurses were welcomed by, identified themselves to, and discussed the purpose of the visit with Associate Executive Director Lane Hermosillo and Resident Service Director Shirley Jones.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's COVID-19 screening, testing, and disinfection processes and the staff’s use of personal protective equipment. During the visit, LPA and HAI nurses briefly toured the facility, interacted with staff, and interviewed the administrator. No deficiencies were cited on this date.

An exit interview was conducted with Hermosillo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1