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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604079
Report Date: 08/01/2022
Date Signed: 08/01/2022 01:35:44 PM


Document Has Been Signed on 08/01/2022 01:35 PM - 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: 138DATE:
08/01/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:David Armour, Executive DirectorTIME COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Amy Domingo and Interim Assistant Program Administrator (IAPA) Icela Estrada conducted a case management visit to discuss a deficiency observed during a complaint investigation visit conducted on August 1, 2022. Upon entry, LPA and IAPA identified themselves to the receptionist and met with and discussed the purpose of the visit with Executive Director (ED) David Armour.

During a complaint investigation visit, IAPA observed four staff wearing a face mask only covering their mouth and five staff to include Staff 1 and Staff 2 (S2) not wearing a face mask. During the visit, IAPA discussed the importance of employees wearing face masks while in the facility with the Executive Director. Later during the visit, IAPA and ED observed S2 not wearing a mask once again and she was asked to put on her mask. During the tour of the memory care unit, IAPA observed two staff wearing a face mask only covering their mouth subsequently both staff adjusted their mask.

During the period of July 17, 2022 and August 1, 2022, the facility had approximately 28 residents in the facility with active COVID-19 diagnoses. Due to the outbreak, on July 28, 2022, the RO conducted an on-site visit with the County of San Diego Healthcare Associated Infection (HAI) team to provide technical assistance and to evaluate the facility's COVID-19 screening, testing, and disinfection processes and staff’s use of personal protective equipment (PPE). During the HAI assessment, Executive Director David Armour and Resident Services Director, Jessica Mallory were present and no deficiencies were cited during the visit. The ED was provided with Confidential Names List (LIC 811) to identify Staff 1 and Staff 2.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MESA
FACILITY NUMBER: 374604079
VISIT DATE: 08/01/2022
NARRATIVE
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During today’s visit, a deficiency was cited per California Code of Regulations, Title 22 on the attached Deficiency page (LIC 9099-D). An exit interview was conducted with Executive Director David Armour which included developing a plan of correction for the deficiency. A copy of this report, LIC 809, LIC 809-D, LIC 811, and the Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/01/2022 01:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 MESA
FACILITY NUMBER: 374604079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/08/2022
Section Cited

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Personal Rights of Residents in All Facilities
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations, the licensee did not accord healthful accomodations in 138 of 138 persons in care
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which posed a potential health and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3