374604784-3-25-2024-08-AS-CLOZ-D3PVV9-20240325164558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604784
Report Date: 03/25/2024
Date Signed: 03/25/2024 04:46:47 PM

Document Has Been Signed on 03/25/2024 04:46 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:	BAYSHIRE TORREY PINES		FACILITY NUMBER:	374604784
ADMINISTRATOR:	KIRBY, SCOTT		FACILITY TYPE:	741
ADDRESS:	13101 HARTFIELD AVE		TELEPHONE:	(858) 259-2222
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92130
CAPACITY:	125	CENSUS:	DATE:	03/25/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Executive Director Jermey Danenhauer		TIME COMPLETED:	04:50 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’s (LPA’s) Carmen Lopez and Ryan Fulton conducted an announced Pre-Licensing with the Component III inspection, and to observe the facility’s physical plant for complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA’s were greeted at the front entrance by the Executive Director Jermey Danenhauer, Assistant Administrator Veronica Merlos, and Lizzie Dela Fuente and was granted entry after identifying themselves and disclosed the purpose of their visit. The facility is undergoing a change of ownership. The fire clearance was approved on 12/20/2023 and reflected that the facility was approved for 125 residents for Residential Care Facility for the Elderly (RCFE) – Continuing Care Retirement Community (CCRC); all 125 of whom may be non-ambulatory, of which 39 may be bedridden. All rooms are approved for bedridden. Delayed egress is approved for memory care unit and waiver is granted for hospice care for 17. As of today's visit, there were 89 residents in care. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPAs accompanied by Executive Director Jermey Danenhauer, and Assistant Administrator Veronica Merlos, conducted an overall inspection of the internal and external areas of the facility. There are eight number of bathrooms for residents to use. The facility has all the required furnishings, linens and personal hygiene items. Bathrooms are equipped with grab bars and non-skid mats or stickers. The facility was clean, sanitary, and in good repair. Resident bedrooms allowed for easy passage with no obstruction and contained the required furnishings. Toilets, sinks, and showers were in working order. Each window had a screen which was in good condition. The facility’s ambient internal temperature was compliant at 74 degrees F. Hot water temperature at taps accessible to residents were also compliant: 1^st floor bathroom sink was 119.2, second first floor bathroom sink was 118.2, second floor spa bathroom sink was 117.2, second floor bathroom sink was 117.5 assisted living 3^rd level 113 degrees bathroom 2 118.8 and bathroom 3 was 118.1 there were six resident bedrooms that measured hot water that are in compliance with regulation.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: BAYSHIRE TORREY PINES	FACILITY NUMBER: 374604784
	VISIT DATE: 03/25/2024

NARRATIVE

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All outdoor and indoor pathways were free from obstruction and slip hazards. Fire extinguishers were serviced within the last 12 months and affixed with current tags. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were present and operational. There are 21 fire extinguishers that are in compliance with regulations.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has no pools or bodies of water that were observed on the facility premises. Per the Executive Director Jeremy Danenhauer, no firearms or ammunition are or will be stored on the facility premise.

All toxic substances/poisons, chemicals were stored in an inaccessible area which is inaccessible to residents. Fireplaces, and/or open-faced heaters were inaccessible to residents.

The facility has locked areas for storage of sharp objects. The facility kitchen was stocked with appropriate cooking items, knives locked in a secure cabinet which is inaccessible to residents. A seven (7) day non-perishable and two (2) day perishable food supply was present.

Medications were secured in a locked cabinet which is inaccessible to residents. A first aid kit and manual were present and located in each of the med rooms and the front entrance. Resident and staff files were also in a locked cabinet. Required licensing postings were observed in visible areas of the facility.

LPAs discussed continuing operation requirements, record keeping, reporting requirements and physical plant compliance with the applicant. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

The Pre-Licensing and Component III was completed during today’s visit. The applicant was advised that the facility is ready for licensure pending management final review and approval.

An exit interview was conducted with applicant, Jermey Danenhauer, to whom a copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The signature below confirms receipt of these documents.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen Lopez	TELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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