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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604545
Report Date: 10/14/2022
Date Signed: 10/18/2022 10:53:10 AM


Document Has Been Signed on 10/18/2022 10:53 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GARDENS AT ESCONDIDOFACILITY NUMBER:
374604545
ADMINISTRATOR:BANAGA, AMYFACILITY TYPE:
740
ADDRESS:1342 NORTH ESCONDIDO BLVDTELEPHONE:
(760) 480-8155
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:101CENSUS: 56DATE:
10/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Ferlina McBrideTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Janira Arreola, made a visit to the facility in order to conduct a prelicening inspection. LPA met with Ferlina McBride, assistant executive director.

The facility is doing a change of ownership from Ventas Operating Holdings AOC to Pacifica CA LLC. LPA reviewed the pre licensing materials submitted by the applicant such as the facility sketch, emergency disaster plan, evacuation route, and infection control plan.

LPA also reviewed the current administrator's certificate and found that McBride's certificate is currently pending with the department. LPA conducted a walk through of the interior and exterior of the facility. The fire clearance dated 8/22/2022 indicated the facility is licensed for 101 residents, with 91 ambulatory and 10 for bedridden residents. (1) of the facility elevators is currently out of service with expected repair date of 10/17/2022. The facility also had a flood the week prior and had (9) resident units flooded with water from the main street line. This piping has been repaired 10/10/2022. The repairs to the resident rooms are excepted to be completed by 11/14/2022. LPA also reviewed the facilities current balance on current license number 374603456, and found that the facility has an outstanding balance of $2.973.00. The administrator stated that the facility would be reaching out to the prior owner.

This information will be relayed to the CAB Analyst to inform that at this time the facility must make the appropriate repairs in order to obtain the new license.

An exit interview was conducted with Felrina McBride, and copy of this report was reviewed and provided to her.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
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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