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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604784
Report Date: 02/25/2025
Date Signed: 02/25/2025 03:09:23 PM

Document Has Been Signed on 02/25/2025 03:09 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 PINESFACILITY NUMBER:
374604784
ADMINISTRATOR/
DIRECTOR:
JEREMY DANENHAUERFACILITY TYPE:
741
ADDRESS:13101 HARTFIELD AVETELEPHONE:
(858) 259-2222
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY: 125CENSUS: 91DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Executive Director Jeremy Danenhauer and Resident Service Director Lizzie De La Fuente MisticaTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Executive Director Jeremy Danenhauer and Resident Service Director Lizzie Dela Fuente Mistica. The facility's license shows a maximum capacity of 125 non-ambulatory residents, of which 39 may be bedridden. Hospice waiver for 17. Delayed egress approved for Memory Care Unit. During today’s inspection there were 91 residents in care.

LPA with Resident Service Director De La Fuente Mistica toured the interior and exterior of the facility, and inspected a sample of rooms. Pathways were free of obstruction and slip hazards.The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. Per Resident Service Director De La Fuente Mistica, no firearms or ammunition are kept at the facility. Carbon monoxide detectors and emergency lighting were in working order. Fire extinguisher(s) were serviced within the last 12 months. Required licensing postings were observed in visible areas of the facility.
 
LPA reviewed facility records. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

No deficiencies were cited during the inspection. An exit interview was conducted with Resident Service Director De La Fuente Mistica to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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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