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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604457
Report Date: 12/02/2021
Date Signed: 12/02/2021 01:57:36 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:OAKMONT OF ESCONDIDO HILLSFACILITY NUMBER:
374604457
ADMINISTRATOR:SENTENO, CAROLINEFACILITY TYPE:
740
ADDRESS:3012 BEAR VALLEY PARKWAYTELEPHONE:
(760) 735-8084
CITY:ESCONDIDO HILLSSTATE: CAZIP CODE:
92025
CAPACITY:160CENSUS: 111DATE:
12/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Executive Director John BrennanTIME COMPLETED:
12:50 PM
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Licensing Program Manager (LPM) John Rante and Licensing Program Analyst (LPA) Kayla Hilario, conducted an unannounced Case Management Visit. LPM and LPA met with Executive Director John Brennan, and we discussed the purpose of the visit.

Today's visit is in response to the self-reported death of Resident 1 (R1 - see LIC811 Confidential Names List). R1 passed away at the facility, date of death: 11/26/2021.

LPM and LPA conducted a wellness check at the facility, and no health or safety issues were identified. Residents observed appeared appropriate for the facility. Additional information was obtained on this date regarding R1's death.

No deficiencies were cited or observed on this date.

An exit interview was conducted. The Licensee will be provided a copy of their appeal rights (LIC9056 01/16), via email, along with a copy of this report. An electronic read receipt will serve as confirmation of receipt of documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
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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