374604227-1-25-2024-08-AS-AROS-CZU36R-20240125165845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604227
Report Date: 01/23/2024
Date Signed: 01/25/2024 04:59:19 PM

Document Has Been Signed on 01/25/2024 04:59 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:	SUMMERFIELD OF ENCINITAS		FACILITY NUMBER:	374604227
ADMINISTRATOR:	MYERS,HEATHER		FACILITY TYPE:	740
ADDRESS:	1350 S. EL CAMINO REAL		TELEPHONE:	(760) 479-1818
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	56	CENSUS: 50	DATE:	01/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Business Officer Manger, Janelle Harris		TIME COMPLETED:	03:00 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 Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Community Relations Director, Claudia Miner, after identifying herself and stating the purpose of the inspection. This facility serves fifty-six residents, 60 and above. all of which are non-ambulatory. Approved for hospice for twenty residents. This facility has delayed egress as well as locked perimeter. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. This a one story building with four wings. There are no water features on site. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with the required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Common showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. The facility is operating in accordance with their fire clearance. The smoke and carbon monoxide alarms were present in each building. Emergency lighting, and facility telephone were all working. First aid kit(s) were complete and readily accessible in the medical rooms. Required licensing postings were observed in visible areas of the facility. PPE supplies are on site. Passageways were free from obstructions.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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: SUMMERFIELD OF ENCINITAS	FACILITY NUMBER: 374604227
	VISIT DATE: 01/23/2024

NARRATIVE

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[CONTINUED FROM 809-C]

Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Emergency food supplies were kept in kitchen. Food supply is replenished frequently by outside vendors. Food was observed to be properly labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Centrally stored medications were properly stored and locked in medication carts. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions.

Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPA conducted a review of In-service training procedures. Transportation procedures are compliant. LPA interview indicates medical and dental needs for residents are being met.

There is designated recreation room to accommodate activities such as daily exercises, musical performances, and arts/crafts.At the time of visit, LPA observed an large group activity, in which many residents in the memory care unit were participating. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

No deficiencies were issued at the time of visit; however, technical violations was issued at today’s visit.

An exit interview was conducted with Business Officer Manger, Janelle Harris to whom copies of this report, the LIC 9102TV's, and Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC809 (FAS) - (06/04)

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