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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 10/07/2020
Date Signed: 10/07/2020 03:01:34 PM

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:AMIRHOUSHMAND,SHAWNFACILITY TYPE:
740
ADDRESS:955 GRAND AVETELEPHONE:
(858) 373-9300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92109
CAPACITY:92CENSUS: 74DATE:
10/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Health Services Director, Nicole-Jane AlfaroTIME COMPLETED:
02:52 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced Case Management via Zoom due to COVID-19. LPA Hamilton identified herself and explained the purpose of the visit with Health Services Director, Nicole-Jane Alfaro.

Today's visit was in response to Incident Reports the Department received on 09/11/2020, 09/13/2020 and 09/15/2020. During today's visit, LPA interviewed staff, requested resident and facility records and briefly toured the facility.

An exit interview was conducted with Health Services Director, Nicole-Jane Alfaro and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Nicole-Jane Alfaro via email with an electronic read receipt.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020
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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