<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601035
Report Date: 01/03/2025
Date Signed: 01/03/2025 02:50:09 PM

Document Has Been Signed on 01/03/2025 02:50 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:LUCY'S PLACEFACILITY NUMBER:
374601035
ADMINISTRATOR/
DIRECTOR:
LUCIA B.TOTANESFACILITY TYPE:
740
ADDRESS:4770 ELM TREE DRIVETELEPHONE:
(760) 806-3873
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 6CENSUS: 2DATE:
01/03/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Caregiver Victoria DaoTIME VISIT/
INSPECTION COMPLETED:
03:00 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 (LPA) Rebecca Borunda conducted a plan of correction visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Caregiver Victoria Dao.

The purpose of the visit was to verify if the deficiencies issued on 12/6/2024 had been corrected. On 12/6/2024, the licensee was issued deficiencies 87465(h)(2) and 87465(h)(5) regarding medication management and storage with a correction due date of 12/31/2024. On 12/31/2024, Licensee Lucia Totanes submitted copies of medication training for staff as proof of correction for both deficiencies to the Department.

During today’s visit, LPA Borunda conducted a brief walk through of the facility, observed a resident in care, and reviewed resident medications. LPA observed that residents' medications were stored in bubble packs and pill bottles in the facility's locked medication cabinet. LPA visually verified that medications were no longer stored in multi-day pill boxes and were not stored outside of the facility's locked medication cabinet. LPA observed that resident medications were stored in their original container and were labelled with the resident's prescription. Per Caregiver Dao, the pill boxes containing resident medications were removed from the unsecured cabinet and residents are receiving medications directly from their pill bottles or bubble packs. Caregiver Dao also verbally confirmed that staff received medication training from the medical professional listed in the correction documents submitted by Licensee Totanes. Based on the submitted documents and the observations during today's visit, the deficiencies 87465(h)(2) and 87465(h)(5) are corrected. LPA provided Caregiver Dao with a Letter of Deficiency Cited Cleared.

An exit interview was conducted with Caregiver Victoria Dao, whose signature below confirms receipt of a copy of this report, Letter of Deficiency Cited Cleared, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Borunda
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1