374604457-8-28-2023-18-AS-CGOH-CV5SFL-20230828135032

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604457
Report Date: 08/28/2023
Date Signed: 08/28/2023 01:50:41 PM

Document Has Been Signed on 08/28/2023 01:50 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	OAKMONT OF ESCONDIDO HILLS		FACILITY NUMBER:	374604457
ADMINISTRATOR:	BRENNAN, JOHN		FACILITY TYPE:	740
ADDRESS:	3012 BEAR VALLEY PARKWAY		TELEPHONE:	(760) 735-8084
CITY:	ESCONDIDO HILLS	STATE: CA	ZIP CODE:	92025
CAPACITY:	160	CENSUS: 8138	DATE:	08/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Director, Salvador Jimenez		TIME COMPLETED:	01:49 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/28/23 at 9:29 a.m. Licensing Program Analyst (LPA) Cheryl Goodrich arrived to conduct an unannounced annual visit. LPA met with Director Sal Jimenez and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. The facility is approved for one hundred and sixty (160) ambulatory and non-ambulatory residents, having 138 residents in care. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, cleaning supplies, protective eye equipment and cleaning supplies. Physical Plant and Environmental Safety: The facility has bedrooms with bathrooms for each resident, a kitchen, living room, office area, a walled pool area, independent living computer room, fitness center, laundry area, salon and a memory care area. All a kitchen, living room, office area, a walled pool area, independent living computer room, fitness center, laundry area, salon and a memory care area are all clean and clear of obstruction. The resident bedrooms were clean and clear from obstruction. The resident’s rooms were complete with and clean linens and bedding, a television, dresser, and closet space. There is a pool on the premises that meets the height requirements for the facility. Operational Requirements: The facility was staffed with 25 staff to assist residents. The facility meets the operational requirements for an RCE and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguishers. (Continued on LIC809-C)

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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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Document Has Been Signed on 08/28/2023 01:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAKMONT OF ESCONDIDO HILLS	FACILITY NUMBER: 374604457
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Deficiency Dismissed

Type A

Section Cited

CCR

87458(b)(1)

Medical Assessment

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on resident record review, the licensee did not comply with the section cited above in 7 out of 10 resident physician reports poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/05/2023
	Plan of Correction
1 2 3 4	The Director, Sal Hernandez agrees to complete the annual physician reports and put them on schedule so they are not missed. The Health Services Director and himself will work to continue to put the physician reports on the calendar and have them completed prior to inspection annually.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAKMONT OF ESCONDIDO HILLS	FACILITY NUMBER: 374604457
	VISIT DATE: 08/28/2023

NARRATIVE

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Personnel Records-Training: All staff have fingerprint clearances, current CPR/First Aid certification, Health screen and TB test completed. All staff complete monthly in-service training and fire-drills and disaster training.
Client Records-Incident Reports: The resident records are complete with pre-assessments, admissions agreement, identification and emergency information,house rules, medication log, daily logs of the resident’s health condition, and additional medical assessments.
Client Rights-Information: The resident’s right documentation is present. The resident records also contain needs assessment information for each resident.
Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents upon request.
Health- Related Services: The caregivers at the facility are dispensing medications within the guidelines of the physician’s order and the regulations. The facility is documenting the date and time of the dispensing of medication for each resident.
Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 08/08/23. The facility has emergency supply of food and water.
Deficiencies: LPA reviewed resident’s records and found there are 7/10 resident records that do not have current physician’s reports for the year. Based on the reviewed records a deficiency is being cited.
Summary: Deficiencies are being cited per Title 22, Div. 6, Chap 8 and listed on LIC 809-D. An exit interview was conducted, Appeal Rights (LIC 9098 01/16) along with a copy of this report was provided to Director Sal Jimenez and his signature on this form confirms receipt of these rights.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC809 (FAS) - (06/04)

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