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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604545
Report Date: 06/24/2024
Date Signed: 06/24/2024 03:38:57 PM


Document Has Been Signed on 06/24/2024 03:38 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:GARDENS AT ESCONDIDOFACILITY NUMBER:
374604545
ADMINISTRATOR:MCBRIDE, FERLINAFACILITY TYPE:
740
ADDRESS:1342 NORTH ESCONDIDO BLVDTELEPHONE:
(760) 480-8155
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:101CENSUS: 56DATE:
06/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Parris McDaniel, Memory Care DirectorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Memory Care Director Parris McDaniel, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident of Resident 1 (R1 - see LIC811 Confidential Names List) who exited the facility without staff knowledge or assistance.

LPA interviewed staff and residents and collected records. A wellness check was completed; no health or safety issues were identified. 

An exit interview was conducted with Memory Care Director Parris McDaniel, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Their signature confirms receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024
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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