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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604143
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:28:15 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:OCEAN HILLS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
374604143
ADMINISTRATOR:KURT NORDENFACILITY TYPE:
740
ADDRESS:4500 CANNON RDTELEPHONE:
(619) 865-2614
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:140CENSUS: 81DATE:
03/06/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Kurt Norden, DirectorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Jonathan Pineda made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified himself and was granted entry into the facility by Kurt Norden, Director. The facility is licensed to serve one hundred forty (140) elderly residents; ages 60 and above; all of whom may be non-ambulatory. The facility has an approved hospice waiver for ten (10) residents.

An overall inspection of the facility was conducted inside and out. The facility temperature was 77 degrees F during time of visit. The facility has one or more functioning carbon monoxide/smoke detector. Disinfectants, cleaning solutions, and poisons are locked and were observed inaccessible to residents. Hot water temperature measured at 107-111 degrees F for the bathrooms used by the residents. All toilets, hand washing, and bathing facilities were observed in sanitary condition with available grab bars. Bathing facilities have non-skid surfaces. LPA observed linens clean and in good repair. Lamps and lights are provided in all rooms. All of the resident rooms had the required furnishings. A one (1) week’s non-perishable food supply was observed on the property. A two (2) day supply of perishable food was observed on the property. All food was properly stored and made available to residents. All outdoor/indoor passageways were observed free from obstruction. Facility has a functional signal system that operates from each resident's living unit. Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained criminal background clearance and/or an exemption. Staff responsible for direct care and supervision have current First Aid/CPR training. Last fire drill was conducted on 12/9/19. Each resident has a written admission agreement, needs and service plan, and physician’s report on file. Kurt Norden's Administrator Certificate expires on 4/6/21. Liability insurance is current.

Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed and a copy along with Licensee Rights (01/16) was provided to Kurt Norden, Director.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C PinedaTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020
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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