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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604062
Report Date: 08/31/2021
Date Signed: 08/31/2021 03:33:13 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:ELMCROFT OF POINT LOMAFACILITY NUMBER:
374604062
ADMINISTRATOR:SHEARER, KELLIEFACILITY TYPE:
740
ADDRESS:3423 CHANNEL WAYTELEPHONE:
(619) 224-7300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:60CENSUS: 45DATE:
08/31/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Executive Director Kellie ShearerTIME COMPLETED:
10:55 AM
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) Rebecca Ruiz and County of San Diego Nurse Contractors, Elizar Perez and Jennifer West with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Executive Director Kellie Shearer.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Executive Director and conducted a walk-though of the facility. A debriefing was conducted with the Executive Director at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with the Executive Director Kellie Shearer to whom a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided via electronic mail. An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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