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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604318
Report Date: 06/22/2021
Date Signed: 06/24/2021 12:30:09 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:WESTMONT OF ENCINITASFACILITY NUMBER:
374604318
ADMINISTRATOR:TORTORELLI, TORRIEFACILITY TYPE:
740
ADDRESS:1920 SOUTH EL CAMINO REALTELEPHONE:
(858) 729-6720
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:101CENSUS: 0DATE:
06/22/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Administrator, Charles Bloom and Regional Director of Operations, Maria RossTIME COMPLETED:
06:15 PM
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Licensing Program Analysts (LPAs), Kristina Ryan, and Debbie Correia conducted an announced Pre-Licensing visit to observe the facility's compliance with Title 22, Division 6 regulations and the California health and safety code. LPAs met with Administrator, Charles Bloom and Regional Director of Operations, Maria Rossi. Facility is applying to serve one hundred and one (101) residents over 60 years of age. All rooms at the facility are approved for non-ambulatory use.

During today's visit LPAs, accompanied by Administrator Bloom and Regional Director of Operations, Maria Rossi, conducted a facility tour. LPA's observed resident rooms and found them to have proper furnishings, and adequate linens. Sinks accessible to residents had water temperatures measured between and 109.6 to 118.8 degrees Fahrenheit. Facility temperature was read at 72 degrees Fahrenheit. Facility had multiple working fire extinguishers. Smoke and carbon monoxide alarms were observed and operational. The Encinitas Fire Department granted clearance on May 24, 2021. Facility had preparation space for food service and kitchen was observed to have all needed supplies for food service. Space inside the facility is sufficient for activities. Administrator stated that there will be no weapons or ammunition kept on the facility property. Facility has an indoor pool with a locked entrance that meets the requirements of Title 22. Staff and resident records will be stored in a locked cabinet. There is a shaded outdoor space and appropriate resident activities.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: WESTMONT OF ENCINITAS
FACILITY NUMBER: 374604318
VISIT DATE: 06/22/2021
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All cleaning supplies or potentially hazardous materials were locked. Facility has a locked area for resident medications and first aid kits. Administrator Certificate expires on February 6, 2022 . Component III was reviewed with the Administrator Charles Bloom Regional Director of Operations Maria Rossi. The application will be sent to the Centralized Application Bureau for final review and approval.

An exit interview was conducted with Administrator, Charles Bloom and Regional Director of Operations, Maria Rossi. A copy of this report and Licensee Appeal Rights (LIC 9058 01/16) was provided vie email. An electronic read receipt confirms receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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