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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 02/04/2022
Date Signed: 02/04/2022 03:47:42 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: 20DATE:
02/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensed Vocational Nurse, Marjorie PacquingTIME COMPLETED:
01:34 PM
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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to check on the health and welfare of residents in care. LPA discussed the purpose of the visit and met with Licensed Vocational Nurse (LVN), Marjorie Pacquing

During today's visit, LPA briefly toured the facility and conducted health and safety check, interviewed staff, and obtained copies of resident records. No deficiencies were cited during the visit.

An exit interview was conducted with Marjorie Pacquing, LVN and copies of this report and Licensee Rights (LIC 9098 01/16) were emailed to the Executive Director following the visit. An electronic read receipt was requested as proof of confirmation of documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2022
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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