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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604227
Report Date: 11/23/2022
Date Signed: 11/23/2022 11:24:12 AM


Document Has Been Signed on 11/23/2022 11:24 AM - 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:SUMMERFIELD OF ENCINITASFACILITY NUMBER:
374604227
ADMINISTRATOR:MYERS,HEATHERFACILITY TYPE:
740
ADDRESS:1350 S. EL CAMINO REALTELEPHONE:
(760) 479-1818
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:56CENSUS: 35DATE:
11/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Richard MarionaTIME COMPLETED:
11:31 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced case management visit to cite a deficiency noted during the complaint investigation visit today at another licensed facility. LPA met with Resident Services Director Richard Mariona and we discussed purpose of the visit.

The following deficiency was noted: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.

On January 27, 2022 LPA Serrano observed a sign posted on the main entrance door of the facility. The sign read; “Stop, due to covid-19 no visitors. In an effort to reduce the risk covid-19 exposure and to help prevent the spread of the virus, we are not allowing visitors at this time.”

Per Title 22, Division 6, Chapter 8 of the California Code of Regulations, the following deficiency is cited and listed on LIC809-D.

It should be noted that Provider Information Notice (PIN) 22-04-ASC dated January 18, 2022 indicated; licensees shall allow indoor visitation, including communal dining and in-room visitation, at all times and for all residents regardless of vaccination status of the resident, if (1) the visitor is fully vaccinated, have had all recommended booster doses based on the table below and provide evidence of a negative COVID-19 test within one day of visitation for antigen tests, and within two days of visitation for Polymerase Chain Reaction (PCR) tests; OR (2) permit only outdoor visitation for those that do not meet all the aforementioned requirements in this section.

An exit interview was conducted with Richard Mariona to whom a copy of this report and the Appeal Rights (LIC9058 01/16) were provided to licensee.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
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 11/23/2022 11:24 AM - 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: SUMMERFIELD OF ENCINITAS
FACILITY NUMBER: 374604227

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

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To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.This requirement has not been met as evidenced by:
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Based on LPA observation the licensee did not allow residents to have their visitors...permitted to visit privately during reasonable hours and without prior notice, 1 in 1 of [total numbers] persons in care [R1] which posed a potential 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: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon SerranoTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2022
LIC809 (FAS) - (06/04)
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