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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604318
Report Date: 02/13/2024
Date Signed: 02/13/2024 05:00:12 PM


Document Has Been Signed on 02/13/2024 05:00 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:WESTMONT OF ENCINITASFACILITY NUMBER:
374604318
ADMINISTRATOR:NEWTON, RANDALFACILITY TYPE:
740
ADDRESS:1920 SOUTH EL CAMINO REALTELEPHONE:
(760) 452-6037
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:101CENSUS: 82DATE:
02/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Randal Newton, Executive DirectorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Randal Newton, Executive Director, to discuss the purpose of the visit.

Today's visit is in response to the self reported death of Resident 1 (R1 - see LIC811 Confidential Names List). R1 passed away on 2/11/24.

LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date.

An exit interview was conducted with Randal Newton, Executive Director, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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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