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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604079
Report Date: 07/28/2022
Date Signed: 07/28/2022 11:28:22 AM


Document Has Been Signed on 07/28/2022 11:28 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
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) 369-9700
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:164CENSUS: DATE:
07/28/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:David Armour, Executive DirectorTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Amy Domingo conducted an announced Case Management visit, accompanied by nurse contractor Elizar Perez RN, BSN, PHN from the Healthcare Associated Infection (HAI) team of San Diego County Health and Human Services Agency. LPA and HAI nurse were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee David Armour and Jessica Mallory. 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 nurse briefly toured the facility, interacted with staff, and interviewed the licensee. No deficiencies were cited on this date. An exit interview was conducted with David Armour, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022
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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