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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 10/29/2021
Date Signed: 10/29/2021 02:07:47 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:RIDGEVIEW ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374604426
ADMINISTRATOR:DAYNES, ROBERTFACILITY TYPE:
740
ADDRESS:9825 GLEN CENTER DRIVETELEPHONE:
(858) 444-8560
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:64CENSUS: 11DATE:
10/29/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director, Robert DaynesTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA), Natasha Persaud and County of San Diego Nurse Contractors, Sandra Brackman and Robert Montillano conducted an on-site visit. LPA and Nurses identified themselves and discussed the purpose of the visit with Executive Director, Robert Daynes.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, Executive Director was interviewed and a walk-though of the facility was conducted. A debriefing was conducted with the Executive Director at the conclusion of the visit. No deficiencies were issued today.

An exit interview was conducted with the Executive Director and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Executive Director via electronic mail. An electronic receipt of confirmation was requested to be sent by the Executive Director upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
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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