374604404-8-26-2021-08-AS-KRYN-C69P4F-20210826105906

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604404
Report Date: 08/25/2021
Date Signed: 08/26/2021 11:00:21 AM

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:	TRUEWOOD BY MERRILL, OCEANSIDE		FACILITY NUMBER:	374604404
ADMINISTRATOR:	PEREZ, MARIANO		FACILITY TYPE:	740
ADDRESS:	3500 LAKE BOULEVARD		TELEPHONE:	(206) 676-5300
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92056
CAPACITY:	175	CENSUS: 116	DATE:	08/25/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Executive Director, Mariano Perez		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs), Kristina Ryan and Alexandre Vo, conducted an announced Pre-Licensing inspection. LPAs identified themselves to Executive Director, Mariano Perez, and explained the purpose of the visit which was to evaluate Title 22 compliance for a Change of Ownership application. The facility plans to serve elderly residents, ages 60 and over. The Fire Clearance was granted on July 21, 2021. Facility is approved for 175 non-ambulatory residents of which 48 may be bedridden. Hospice Waiver for 20. An inspection of the facility was conducted inside and out. A sample of 9 resident rooms were observed. Bathrooms are equipped with toilets, and hand-washing and bathing facilities are sanitary and in operating condition. Water temperatures ranged from 114.8 degrees to 115.6 degrees Fahrenheit for the resident and common area bathrooms. Each room was set at a comfortable temperature. All lighting fixtures and facility windows were operable and in good condition. Outdoor and indoor passageways were free from obstructions. Fire extinguishers were affixed with current tags. Smoke and carbon monoxide detectors were present and operational. There were no pools or other bodies of water observed on the premises. Locked cabinets and storage areas were identified to store toxic substances, knives, and medication. Hazardous items were stored such that they were inaccessible to residents. Per Executive Director Perez, no weapons or ammunition are or will be stored at the facility.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: TRUEWOOD BY MERRILL, OCEANSIDE	FACILITY NUMBER: 374604404
	VISIT DATE: 08/25/2021

NARRATIVE

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LPAs observed facility accommodations including food supplies, medication storage, first aid kit as well as toiletries and linens. Required CCLD postings were present. LPAs reviewed staff and resident records. Resident records were reviewed which included admissions agreements, physician's reports, and pre-placement appraisals. Staff records were reviewed for criminal background clearance, criminal record statement, and first aid/ CPR training. Component III was waived. Consultation was provided for continuing operational requirements, record keeping, reporting requirements and physical plant compliance. Executive Director's Administrator Certification is in the process of being recertified.

Based on today's inspection, facility's delayed egress requires further review. Based on LPAs observations, there is not a signal system in each living unit of Garden Houses 2 and 3, which house more than 16 residents. The delayed egress is noted in a Technical Advisory. A separate case management was conducted regarding the signal system. A follow-up inspection will be required.

An exit interview was conducted with Executive Director, Mariano Perez. Mr. Perez was informed that the Facility Evaluation Report will be forwarded to management for review. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to Mr. Perez at the conclusion of the visit, an electronic response confirms the receipt of these documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina Ryan	TELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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