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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 02/01/2024
Date Signed: 02/01/2024 04:49:25 PM


Document Has Been Signed on 02/01/2024 04:49 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: 74DATE:
02/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Caroline Senteno and Assisted Living Coordinator Norma MunozTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Executive Director Caroline Senteno. LPA then met with Assisted Living Coordinator Norma Munoz.

Today's visit was follow-up to CCLD’s first visit, which occurred on 10/06/2023. Both visits were in response to licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 10/05/2023. [See LIC 811 Confidential Names List for a description of R1]. Per the report, R1 passed away on 09/25/2023.

During today’s visit, LPA performed a brief facility tour and welfare check on remaining residents, finding no safety concerns. LPA also collected copies of additional pertinent care records and interviewed additional staff.

No deficiencies were cited during today's visit.

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

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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