374604675-4-24-2023-08-AS-DNGN-CR83KM-20230424181922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604675
Report Date: 04/24/2023
Date Signed: 04/24/2023 06:21:10 PM

Document Has Been Signed on 04/24/2023 06:21 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:	GROSSMONT GARDENS SENIOR LIVING		FACILITY NUMBER:	374604675
ADMINISTRATOR:	JONES, REGINALD		FACILITY TYPE:	740
ADDRESS:	5480 MARENGO AVE		TELEPHONE:	(619) 463-0281
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	425	CENSUS: 205	DATE:	04/24/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Applicant's Representative/Executive Director Reggie Jones		TIME COMPLETED:	06:20 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	Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to the applicant's representative, Executive Director Reggie Jones. The facility fire clearance was granted on 03-15-2023 and reflects that the facility was approved for 425 residents in total, of which 404 may be non-ambulatory, and 21 may be bedridden. During today’s visit, LPA, accompanied by the applicant's representative, toured the interior and exterior of the facility and inspected multiple rooms. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperatures were compliant: Common Area Building was 72 F, West Building was 72 F, South Building was 76 F, and East Building was 75 F. Water temperatures at sinks accessible to clients were also complaint: Common Area Building Public Restroom was 113.4 F, West Building Activities Room was 111.4 F, Room W184 was 113.2 F, Room W191 was 109.2 F, Room W283 was 112.6 F, Room W287 was 111 F, Room W291 was 107.8 F, Room W382 was 113.2 F, Room W387 was 114.1 F, Room W391 was 108.F, Room G240 was 113.2 F, Room G243 was 108.3 F, Room G250 was 107.4 F, Room G336 was 118.6 F, Room G345 was 106.9 F, Room G349 was 105.4 F, Room S04 was 113.9 F, Room S08 was 114.4 F, S12 was 117 F, Room S53 was 119.5 F, Room S63 was 115 F, Room S73 was 113.7 F, Room G204 was 112.6 F, Room G210 was 107.8 F, Room G219 was 118.2 F, Room G307 was 117.3 F, Room G314 was 105.4 F, Room G317 was 115 F, Room E211 was 115.7 F, Room E219 was 111.6 F, Room E226 was 110.7 F, Room E306 was 113.2 F, Room E311 was 111.4 F, and Room E320 was 109.9 F. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
	VISIT DATE: 04/24/2023

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
26
27
28
29
30
31
32

[CONTINUED FROM LIC 809]

The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future resident use. All kitchen appliances were in working order. Refrigerator temperatures were compliant: West Building Refrigerator was 40 F, West Building Freezer was -2 F, South Building Refrigerator was 38 F, South Building Freezer was 0 F, East Building Refrigerator was 25 F, and East Building Freezer was -2 F.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of medication and confidential resident and staff records. The facility's swimming pool was secured behind a locked gate and a fence of required height. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant's representative, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last 12 months. Complete first aid kits were present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Jones was advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with Jones, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2