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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604079
Report Date: 09/26/2023
Date Signed: 09/26/2023 10:11:39 AM


Document Has Been Signed on 09/26/2023 10:11 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:WESTMONT OF LA MESAFACILITY NUMBER:
374604079
ADMINISTRATOR:GARCIA, KIMBERLYFACILITY TYPE:
740
ADDRESS:9000 MURRAY DRTELEPHONE:
(619) 369-9700
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:164CENSUS: 132DATE:
09/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kimberly Garcia and Jeunesse HolmesTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Kimberly Garcia and Resident Services Director Jeunesse Holmes.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 09/20/2023). According to the LIC624: on 09/19/2023, facility staff received a call from the La Mesa Police asking if there was someone missing at the facility, giving a description of the person. Three (3) facility staff went to pick up Resident #1 (R1) half a block from the facility premises. Per LIC624 R1 was unharmed, but was unable to state what happened. Facility will fax R1's doctor about the elopement. R1 was placed on alert charting for 3 days. (See LIC811 Confidential Names List for a description of R1.)

During today’s visit, LPA performed a facility tour/welfare check on residents in care, obtained records and reviewed those records, and interviewed staff. LPA also met R1. Based on observation, R1 is safe.

According to R1’s latest LIC602 Physician’s Report (dated 03/31/2023), R1 should be escorted by staff due to cognitive impairment. Interviews and records showed that Licensee has an AWOL Policy, and that staff followed the procedures under "If Resident is Found" Section.

No deficiencies were cited for this incident. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Administrator K Garcia, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Riza Gloria AlvarezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
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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