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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 01/17/2024
Date Signed: 01/30/2024 12:57:44 PM


Document Has Been Signed on 01/30/2024 12:57 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
SO. CAL AC/SC, 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: 77DATE:
01/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Caroline Senteno, Executive DirectorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted a case management visit to investigative the circumstances surrounding a Death Report received on January 16, 2024. LPA met with Executive Director Caroline Senteno and discussed the purpose of the visit.

LPA reviewed R1's facility file, requested relevant records, and conducted interviews. The Death Certificate was also requested during the visit.

No deficiencies were issued during the visit.

An exit interview was conducted with Executive Director Senteno and a copy of this report and Licensee Rights (LIC9058 01/2016) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
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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