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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604404
Report Date: 12/15/2021
Date Signed: 12/15/2021 02:04:11 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: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: 117DATE:
12/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Mariano PerezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst, (LPA), Kristina Ryan, conducted an unannounced case management visit to follow up on an incident report received on November 29, 2021. LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry, and met with Administrator, Mariano Perez

Community Care Licensing (CCL) received an incident report on November 29, 2021 regarding a resident being hospitalized.

During today's visit, LPA reviewed resident records, and interviewed staff. No deficiencies were cited.

An exit interview was conducted with Mariano Perez. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to the administrator at the conclusion of the visit, an electronic response confirms the receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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