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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 04/15/2024
Date Signed: 04/15/2024 05:06:58 PM


Document Has Been Signed on 04/15/2024 05:06 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: 69DATE:
04/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Executive Director, Caroline SentenoTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met with Executive Director, Caroline Senteno and discussed the purpose of the visit.

Community Care Licensing received a self reported incident involving the death of Resident #1 (R1). The Death Report stated on 04/07/24, R1 was found in their bed by staff. R1 had signs of illness and was found with an opened bottle of body wash in their room. R1's Physician' Report dated 07/13/23 indicated R1 had a diagnosis of a Major Neurocognitive Disorder and was allowed direct access to personal grooming and hygiene items without risk. The facility contacted 911 and R1 was transported to the hospital. R1 passed away at the hospital on 04/07/24.

Today, LPA requested records and conducted interviews with staff. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Caroline Senteno whose signature below confirms receipt of these rights.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
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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