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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604143
Report Date: 02/10/2023
Date Signed: 02/10/2023 04:13:32 PM

Document Has Been Signed on 02/10/2023 04:13 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OCEAN HILLS ASSISTED LIVING & MEMORY CAREFACILITY NUMBER:
374604143
ADMINISTRATOR:JOHNSTON, SHERYLFACILITY TYPE:
740
ADDRESS:4500 CANNON RDTELEPHONE:
(760) 295-8515
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 140CENSUS: 104DATE:
02/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:49 PM
MET WITH:Resident Care Director Dennis Prejusa and Executive Director Sheryl JohnstonTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Resident Care Director Dennis Prejusa. Executive Director Sheryl Johnston was on-site and joined LPA later during the visit.

On July 14, 2022, the Licensee submitted an LIC200 Application to the Regional Office (RO) to change the facility's total licensed capacity from (140) residents down to (123) residents, and to increase the bedridden resident capacity from (0) to (10).

On 02-09-2023, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for (123) residents in total, of which one-hundred-thirteen (113) may be non-ambulatory, and ten (10) may be bedridden. The facility’s floor plan remained unchanged.

LPA conducted a tour of the facility and observed no immediate health or safety issues. No deficiencies were cited. The facility sketch/floor plan was consistent with the current layout of the facility.

This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval.

An exit interview was conducted with Prejusa and Johnston, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2023
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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