374604143-2-27-2024-08-AS-JBAD-D2UUUU-20240227145406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604143
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:54:21 PM

Document Has Been Signed on 02/27/2024 02:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	OCEAN HILLS ASSISTED LIVING & MEMORY CARE		FACILITY NUMBER:	374604143
ADMINISTRATOR:	JOHNSTON, SHERYL		FACILITY TYPE:	740
ADDRESS:	4500 CANNON RD		TELEPHONE:	(760) 295-8515
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	123	CENSUS: 116	DATE:	02/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director Sheryl Johnston, Assistant Director Jiovani Anderson Diaz, Business Office Manager Jamie Colon		TIME COMPLETED:	02:55 PM

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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Receptionist Lindsey Sherrod. LPA was later joined by Executive Director Sheryl Johnston, Assistant Director Jiovani Anderson Diaz, and Business Office Manager Jamie Colon.
According to the facility’s license, the facility has a maximum capacity of one hundred twenty-three (123) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of one hundred and sixteen (116) residents in care. This facility does not feature a secured perimeter but has delayed egress doors in memory care unit.

LPA, accompanied by Johnston and Anderson Diaz toured the interior and exterior of the facility, and inspected resident rooms. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

Hot water temperature at taps accessible to clients were all compliant.

There was at least two (2) days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to residents. Medications were labeled, as required, and stored in locked areas.

(CONTINUED ON LIC809-C)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: OCEAN HILLS ASSISTED LIVING & MEMORY CARE	FACILITY NUMBER: 374604143
	VISIT DATE: 02/27/2024

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(CONTINUED FROM LIC809)

No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

Confidential records were stored in locked areas. Johnston also presented proof of current/active business liability insurance.

No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Sheryl Johnston and Jiovani Anderson Diaz to whom a copy of this report and the Licensee/AppealRights(LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC809 (FAS) - (06/04)

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