<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:54:02 PM


Document Has Been Signed on 04/03/2024 02:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:RIDGEVIEW ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374604426
ADMINISTRATOR:PRABHJOT KAURFACILITY TYPE:
740
ADDRESS:9825 GLEN CENTER DRIVETELEPHONE:
(858) 293-3905
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:68CENSUS: 54DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Mona KaurTIME COMPLETED:
03:00 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 (LPA) Nacole Patterson and Ryan Fulton conducted an unannounced Case Management Visit.  LPAs were greeted by and met with Administrator Mona Kaur, to discuss the purpose of the visit. 

Today's visit is in response to three (3) self reported incidents for residents 1, 2 and 3 (see LIC811 Confidential Names List) who suffered falls.

LPAs interviewed staff and residents and conducted a wellness check; no health or safety issues were identified.  No deficiencies were cited or observed on this date. 

An exit interview was conducted with Administrator Mona Kaur, 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: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1