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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604079
Report Date: 08/20/2020
Date Signed: 08/20/2020 03:38:54 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:WESTMONT OF LA MESAFACILITY NUMBER:
374604079
ADMINISTRATOR:ARMOUR, DAVIDFACILITY TYPE:
740
ADDRESS:9000 MURRAY DRTELEPHONE:
(619) 303-0143
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:164CENSUS: 88DATE:
08/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director, David ArmourTIME COMPLETED:
03:37 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted a Tele-Virtual Visit due to COVID-19. LPA identified herself to Executive Director, David Armour, and we discussed the purpose of the visit.

Today's Tele-Virtual Visit is in response to the death of Resident 1 (R1). R1 passed away while under the Sharp Memorial Hospital care on August 14, 2020. LPA Correia discussed the events leading up to R1's passing with CR Resident Service Director, Lean Alambra

No deficiencies were cited or observed at this time.

An exit interview was conducted with the Licensee. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Executive Director, David Armour, via email with an electronic read receipt.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020
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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