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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 09/01/2021
Date Signed: 09/01/2021 03:29:20 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: 75DATE:
09/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Executive Director Caroline SentenoTIME COMPLETED:
03:27 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct a health and safety check and review COVID-19 mitigation strategies. The virtual visit was conducted via FaceTime due to COVID-19 restrictions. LPA met with, identified herself to, and stated the purpose of the virtual visit to Executive Director Caroline Senteno.

During today's visit, LPA toured the facility and interviewed the Executive Director. No deficiencies were issued during this visit.

An exit interview was conducted with Executive Director Caroline Senteno to whom a copy of this report and Licensee's Rights (9058 01/16) were provided via electronic mail. An email receipt confirms the acknowledgement of these documents.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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