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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604722
Report Date: 10/23/2024
Date Signed: 11/04/2024 04:39:05 PM

Document Has Been Signed on 11/04/2024 04:39 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:NOVELLUS CLAIREMONT LLCFACILITY NUMBER:
374604722
ADMINISTRATOR/
DIRECTOR:
LAIRD, CANDIFACILITY TYPE:
740
ADDRESS:5219 CLAIREMONT MESA BLVD.TELEPHONE:
(858) 292-8044
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 214CENSUS: 85DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Executive Director Emily De La BarreTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. . The LPA introduced himself and disclosed the purpose of the visit to Staff Mercedes Heredia. Executive Director Emily De La Barre arrived during the visit and assisted the LPA. The facility was licensed for a capacity of two hundred fourteen (214) non- ambulatory residents. Eight of these residents could be bedridden in bedrooms #124-137. The facility was also approved for a hospice waiver for fifteen (15) residents.

Accompanied by staff, the LPA toured the interior and exterior of the facility, and inspected bedrooms. The facility
was clean, sanitary, and in good repair. Pathways were free of obstructions and slip hazards Bedrooms
contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

There was two days of perishable food and seven days of non-perishable food present, all safely stored.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents.
Medications were labeled and stored in a locked area.

Due to time constraints, a continuation visit on a subsequent day is necessary to complete the annual inspection. No deficiencies were observed, nor cited on today's date.

An exit interview was conducted with Executive Director De La Barre, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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