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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604806
Report Date: 10/25/2024
Date Signed: 10/25/2024 02:42:53 PM

Document Has Been Signed on 10/25/2024 02:42 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:EVEREST AT OCEANSIDEFACILITY NUMBER:
374604806
ADMINISTRATOR/
DIRECTOR:		MCBRIDE, FERLINAFACILITY TYPE:
740
ADDRESS:3500 LAKE BLVD.TELEPHONE:
(760) 414-9411
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 175CENSUS: 86DATE:
10/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Executive Director Ferlina McBrideTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an announced Pre-Licensing visit. LPA was met by Applicant Ferlina McBride and was granted entry into the facility. The purpose of today's visit is to inspect the facility to ensure that it is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 10/17/2024 and the facility is approved for a total of 175 residents, 127 may be non-ambulatory and 48 may be bedridden. The facility is has one main building and two separate memory care buildings, and the facility is approved for delayed egress in the two memory care buildings. The facility has an approved hospice waiver for 50 residents.

During today's visit, LPA toured the facility and inspected each building, including common areas, main kitchen, dining areas, common bathrooms and a random sampling of resident apartments and private bathrooms. The facility was found to be clean, safe, and in good repair with no pathway obstructions and was kept at a comfortable temperature. Common and private bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature was randomly sampled in common and private bathrooms in each building and the temperatures were measured between 105 to 120 degrees Fahrenheit. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for resident medications. Fire extinguishers were observed throughout the facility and found to be in compliance. Functioning carbon monoxide detectors and smoke detectors were observed in the facility. No bodies of water were observed on the premises. LPA observed a 7-day supply of non-perishable food and a 2-day supply of perishable food located in the facility's main kitchen. Required postings were observed in the lobby of the facility. LPA reviewed facility’s Infection Control Plan, Emergency Disaster Plan, and a random sampling of resident and staff files.

Continued on LIC809-C page...
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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: EVEREST AT OCEANSIDE
FACILITY NUMBER: 374604806
VISIT DATE: 10/25/2024
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LPA conducted Component III with the applicant. The topics discussed were continuing operation requirements, record keeping/reporting, and physical plant compliance.

LPA was away from the facility for approximately one hour between 12:20pm and 1:20pm.

Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with the applicant, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
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