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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 07/19/2022
Date Signed: 07/21/2022 10:10:23 AM


Document Has Been Signed on 07/21/2022 10:10 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: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: 39DATE:
07/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Assisted Living Director Lillian Escobar and Administrator Robert BaynesTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced case management visit. LPA identified herself and stated the purpose of the visit with Assisted Living Director Lillian Escobar and Administrator Robert Baynes.

The facility self-reported an incident. The incident was regarding Resident 1(R1) and was reported to Community Care Licensing on July 14, 2022. The facility reported that on July 11, 2022, R1 was sent to the hospital due to back pain, the result of an unwitnessed fall.

On today’s date, LPA toured the facility and conducted a health and safety check. LPA briefly spoke to Lillian and Robert and requested copies of facility records. No immediate health and safety concerns were noted and no deficiencies were cited at this time.

An exit interview was conducted with Lillian Escobar and Robert Baynes, to whom a copy of this report and the LIC9058 Licensee/Appeal Rights were printed and provided at the facility.

SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2022
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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