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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604302
Report Date: 06/27/2024
Date Signed: 06/27/2024 01:01:42 PM

Document Has Been Signed on 06/27/2024 01:01 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:COMPASSIONATE ELDER CAREFACILITY NUMBER:
374604302
ADMINISTRATOR/
DIRECTOR:		COPES, BELLY SFACILITY TYPE:
740
ADDRESS:803 HOLLYRIDGE DRTELEPHONE:
(760) 805-6721
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY: 6CENSUS: 5DATE:
06/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator Belly CopesTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Administrator Belly Copes, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident of Resident 1 (R1 - see LIC811 Confidential Names List) who left the facility without assistance.

LPA interviewed staff and residents and collected records. Interviews and records revealed that R1 was able to leave the facility unassisted per their physician's report. A wellness check was completed; no health or safety issues were identified.  No deficiencies were cited or observed on this date. 

An exit interview was conducted with Administrator Belly Copes, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Their signature confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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