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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808298
Report Date: 03/07/2025
Date Signed: 03/07/2025 06:51:26 PM

Document Has Been Signed on 03/07/2025 06:51 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:JACKIE'S BOARD AND CAREFACILITY NUMBER:
370808298
ADMINISTRATOR/
DIRECTOR:
JACKIE CUNNINGHAMFACILITY TYPE:
735
ADDRESS:10863 EL NOPALTELEPHONE:
6192587390
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 6CENSUS: 6DATE:
03/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Licensee Jackie CunninghamTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Licensee Cunningham and was granted entry into the facility. The facility is licensed to serve six (6) clients, of whom four (4) can be non-ambulatory.

During today’s visit, LPA Correia, accompanied by Licensee Cunningham, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. Hot water temperature at taps accessible to clients were all compliant. Bathrooms used by client's hot water measured at 119.6 F and 119.2 F and the facility temperature was 76 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored and labeled. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications and toxins were stored in locked areas inaccessible to clients in care.



No pools or bodies of water were present, per Licensee Cunningham there is a firearm on the premises that is inaccessible to clients in care. LPA observed a locked safe where the firearm is housed separate from the ammunition/bullets that are inaccessible to clients per mandate. Smoke alarms, carbon monoxide detectors, and facility telephone were all operable. Fire extinguishers were newly purchased. Required licensing postings were observed in visible areas of the facility. All required records for clients and staff were present and current.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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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: JACKIE'S BOARD AND CARE
FACILITY NUMBER: 370808298
VISIT DATE: 03/07/2025
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First aid kit and re cross manual were complete and readily accessible. Last disaster drill was conducted on December 18, 2024.

No deficiencies were cited during today's annual inspection. An exit interview was conducted with Licensee Cunningham to whom a copy of this report and Licensee/Appeal Rights (LIC9058 03/22) will be provided. Signature below confirms receipt of the reports.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC809 (FAS) - (06/04)
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