374604171-10-30-2023-08-AS-DNGN-CX4RXF-20231030132440

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604171
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:26:06 PM

Document Has Been Signed on 10/30/2023 01:26 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 LIVING		FACILITY NUMBER:	374604171
ADMINISTRATOR:	DUCHARME-FRANKLIN, KANDY		FACILITY TYPE:	740
ADDRESS:	768 DOROTHY ST		TELEPHONE:	(619) 444-8270
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	68	CENSUS: 63	DATE:	10/30/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Administrator Jared Green		TIME COMPLETED:	01:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Jared Green. On 07/06/2023, Licensee submitted a written request to the CCLD San Diego Regional Office (RO) applying for approval to lock perimeter fence doors and gates associated with the facility's two (2) memory care buildings, thereby creating a secured perimeter around those areas. The request did not involve locking other perimeter doors of the facility, and did not involve amending the facility's total capacity, bedridden capacity, or floor plan layout. On 09/08/2023, the local fire authority granted an updated fire clearance to the facility. The secured perimeter associated with the facility's memory care buildings was already present on the date of the fire inspection. The fire clearance gave approval for the secured perimeter. During today’s visit, LPA briefly toured facility, interviewed staff, and reviewed pertinent records. LPA verified that the current sketch/floor plan is consistent with the current layout of the facility, and that the facility’s posted evacuation routes have been updated to reflect the locked courtyard fence gate. Per review of the LIC624 Physician's Reports for the residents who live in the facility's memory care section: a) all were diagnosed with dementia or a similar neuro-cognitive disorder, and b) none had as their primary diagnosis a mental disorder unrelated to dementia. Licensee has also informed each resident's responsible person (where applicable) in writing of the use of secured perimeter in the facility's memory care section. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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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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
	VISIT DATE: 10/30/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

In their interviews, staff confirmed: c) without violating residents' personal rights, they attempt to redirect residents who try to leave the facility, d) residents who still insist on leaving are allowed to leave, with staff accompanying them for safety, and e) staff understand that locked perimeter doors/gates are not a substitute for trained staff in sufficient numbers to meet the care and supervision needs of residents.

Licensee has obtained from CCLD an approved waiver to California Code of Regulations, Title 22, Section 87468.1(a)(6). The facility’s disaster drill logs showed at least one drill per quarter was conducted on each of its three work shifts. Licensee’s Plan of Operation describes the facility’s locked perimeter fence gate.

LPA observed no immediate health or safety issues. No deficiencies were cited during today's visit.

This portion of the application process is complete. Pending CCLD management’s final review and approval, the licensee will be sent an updated license to reflect the new fire clearance.

An exit interview was conducted with Green, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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