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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604404
Report Date: 02/24/2022
Date Signed: 02/25/2022 08:12:47 AM


Document Has Been Signed on 02/25/2022 08:12 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: 117DATE:
02/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mariano Perez and Teresa JacksonTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management visit to conduct a health and safety check in regard to an incident report received by Community Care Licensing on February 23, 2022. LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry, and met with General Manager, Mariano Perez and Garden House Director, Teresa Jackson.

During the visit, LPA toured the facility with Ms. Jackson, conducted a health and safety check, and collected records. No immediate health and safety concerns were noted. Facility representatives were informed that more time is needed to review this incident and future visits may be needed.

An exit interview was conducted with Mariano Perez and Teresa Jackson. A copy of this report and Licensee Rights (9058 01/16) were provided to the administrator via electronic mail. An email receipt 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: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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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