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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 08/03/2023
Date Signed: 08/07/2023 06:19:49 PM


Document Has Been Signed on 08/07/2023 06:19 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:OAKMONT OF PACIFIC BEACHFACILITY NUMBER:
374604281
ADMINISTRATOR:CAROLINE SENTENOFACILITY TYPE:
740
ADDRESS:955 GRAND AVETELEPHONE:
(858) 373-9300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:92CENSUS: 76DATE:
08/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director Caroline SentenoTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Caroline Senteno.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 08/03/2023). According to the LIC624: during the evening of 08/01/2023, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of C1.] R1 was returned to the facility unharmed, later that same evening.

During today’s visit, LPA performed a facility tour and welfare check, verifying that R1 was unharmed. LPA tested facility's delayed-egress exit doors, finding that they were operational and complaint with regulation. LPA also collected pertinent care and administrative records, and interviewed R1 and relevant staff.

At the present time, the incident requires further investigation. Possible follow-up telephone calls and/or visits are necessary. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Senteno, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023
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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