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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604722
Report Date: 11/19/2024
Date Signed: 12/03/2024 12:01:52 PM

Document Has Been Signed on 12/03/2024 12:01 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:
11/19/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Executive Director Emily De La BarreTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Continuation Annual Inspection. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Emily De La Barre. 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.

The LPA randomly selected resident bedrooms and bathrooms, tested the water temperature, tested the facility signal system, and confirmed they were within the range required and operational. Bedrooms had the required furnishing, including dressers, bedding and lamps. One carbon monoxide detector was observed and tested during the tour. Licensing postings were visible in different areas of the facility.

Staff and resident records were reviewed during the visit and interview conducted. The LPA provided technical advise and no deficiencies were 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: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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