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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604675
Report Date: 12/31/2024
Date Signed: 12/31/2024 05:33:38 PM

Document Has Been Signed on 12/31/2024 05:33 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:GROSSMONT GARDENS SENIOR LIVINGFACILITY NUMBER:
374604675
ADMINISTRATOR/
DIRECTOR:		JONES, REGINALDFACILITY TYPE:
740
ADDRESS:5480 MARENGO AVETELEPHONE:
(619) 463-0281
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 425TOTAL ENROLLED CHILDREN: 0CENSUS: 379DATE:
12/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Executive Director, Reginald JonesTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident. LPA met with Executive Director, Reginald Jones.

The facility self reported an incident involving Resident #1 (R1). The report indicated on 12/14/24 staff observed R1 walking around with bruising to their eye. The facility's nurse assessed R1 and determined R1 required medical attention. R1 was transported to the hospital for evaluation. It was determined R1 wanted to self harm themselves. R1 was independent of activities of daily living and drives their own vehicle. Executive Director has a plan in place for R1's return to the facility.

No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Reginald Jones whose signature below confirms receipt of these rights.
Robyn ClarkTELEPHONE: (619) 767-2312
Natasha PersaudTELEPHONE: (619) 301-3594
DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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