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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604404
Report Date: 10/13/2021
Date Signed: 10/14/2021 11:08:06 AM

Document Has Been Signed on 10/14/2021 11:08 AM - It Cannot Be Edited

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, OCEANSIDEFACILITY NUMBER:
374604404
ADMINISTRATOR:PEREZ, MARIANOFACILITY TYPE:
740
ADDRESS:3500 LAKE BOULEVARDTELEPHONE:
(206) 676-5300
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 175CENSUS: 114DATE:
10/13/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle Furhman and Mariano PerezTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst, Kristina Ryan, and County of San Diego Nurse HAI Site Assessment Contractor, Robert Montillano conducted an on-site visit. The team identified themselves and discussed the purpose of the visit with Resident Care Director, Michelle Furhman and Administrator, Mariano Perez

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Mr. Perez and conducted a walk-through of the facility. A debriefing was conducted with Mr. Perez at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Mr. Perez and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the administrator via electronic mail. An electronic receipt confirms receipt of the documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Kristina Ryan
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2021
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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