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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604426
Report Date: 12/28/2022
Date Signed: 12/28/2022 04:46:57 PM


Document Has Been Signed on 12/28/2022 04:46 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
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: 40DATE:
12/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Resident Services Director Lilllian EscobarTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA was allowed entry by the receptionist. LPA met with, identified herself, and disclosed the purpose of the visit with Resident Services Director Lilllian Escobar.

Today's visit is in response to the self-reported incident which occurred approximately around 11/14/2022 regarding an incident between Staff 1 (S1) and Resident R1 (for a description of S1 and R1 - see LIC811 Confidential Names List).

LPA conducted a wellness check at the facility by interviewing staff, a private caregiver, and R1. LPA observed that the residents in care appeared appropriate for the facility. LPA also collected resident records. The facility staff have conducted their own investigation and while inconclusive, have determined that S1 will not work with R1 moving forward.

No deficiencies were cited or observed on this date.

An exit interview was conducted with the Resident Services Director Lilllian Escobar. A copy of this report and appeal rights (LIC9056 03/22), were provided via hardcopy.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: 619-481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
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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