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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604171
Report Date: 09/13/2023
Date Signed: 09/13/2023 04:41:00 PM


Document Has Been Signed on 09/13/2023 04:41 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:LO-HAR SENIOR LIVINGFACILITY NUMBER:
374604171
ADMINISTRATOR:DUCHARME-FRANKLIN, KANDYFACILITY TYPE:
740
ADDRESS:768 DOROTHY STTELEPHONE:
(619) 444-8270
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:68CENSUS: 63DATE:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Jared Green and Wellness Coordinator Jenna PurnellTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit – Other visit to review records. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Jared Green and Wellness Coordinator Jenna Purnell.

During today’s visit, LPA briefly toured the facility and interviewed the administrator and other staff. LPA also reviewed disaster drill records, posted sketches showing evacuation routes, and the LIC602 Physician’s Reports for the residents who reside in the facility’s memory care areas.

During record review, LPA observed: Licensee did not possess an LIC602 Physician’s Report or equivalent Medical Assessment for Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1.] One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC809-D). A Plan of Correction was jointly developed with the licensee.

LPA also provided Technical Assistance (TA) regarding reporting requirements and requirements related to use of secured perimeter doors (refer to the attached LIC9201-TA pages).

An exit interview was conducted with Green and Purnell, to whom a copy of this report, the LIC809-D, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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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Document Has Been Signed on 09/13/2023 04:41 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: LO-HAR SENIOR LIVING
FACILITY NUMBER: 374604171

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
87465(a)

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87458 Medical Assessment: “(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment.”
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Licensee agreed to coordinate with R1’s physician to obtain a current LIC602 Physician’s Report for R1. Licensee agreed to retrain its marketing/admissions staff and management team on required documents for every resident, by time of move-in. Licensee agreed to E-mail a copy of R1’s LIC602 and the training sign-in sheet, to LPA by the POC due date.
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This requirement was not met, as evidenced by: Based on records and interviews, for 1 of 63 residents (R1), prior to their acceptance as a resident, licensee did not obtain and keep on file, documentation of a medical assessment, signed by a physician, which posed a potential health, safety, 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: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
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