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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604281
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:18:00 PM


Document Has Been Signed on 09/19/2022 04:18 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: 75DATE:
09/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Caroline SentenoTIME COMPLETED:
04:20 PM
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Licensing Program Manager (LPM) John Rante and Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Case Management visit. LPM and LPA identified themselves to the Administrator,Caroline Senteno, and we discussed the purpose of the visit.

Today's visit is in response to self-reported AWOL of Resident 1 (R1 - see LIC811 Confidential Names List), date of incident: September 13, 2022.

LPM and LPA conducted a tour of the facility, and interacted with residents and staff. Additional facility records were also obtained on this date. No immediate health or safety issues were identified during today's visit.

No deficiencies were cited or observed on this date. The Licensee was provided a copy of their appeal rights (LIC9058 08/22) and their authorized representative's signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided to Caroline Senteno.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Riza Gloria AlvarezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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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