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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808451
Report Date: 07/12/2023
Date Signed: 07/12/2023 04:25:31 PM

Document Has Been Signed on 07/12/2023 04:25 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:MORNING BREEZE HOMEFACILITY NUMBER:
370808451
ADMINISTRATOR:GARCIA, EMERITAFACILITY TYPE:
735
ADDRESS:1630 MORNING BREEZE LANETELEPHONE:
(619) 472-1163
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 6CENSUS: 1DATE:
07/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Caregiver Princess DavidTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Princess David. LPA also spoke with Administrator Emerita Garcia via phone during the visit.

Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 07/11/2023. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 07/10/2023.

LPA performed a brief facility tour and welfare check on the one (1) remaining client in care, who reported that they were safe and doing well. LPA also reviewed pertinent records and interviewed relevant staff.

No deficiencies were observed or cited during today's visit. However, LPA provided Technical Assistance to Licensee regarding a chirping smoke detector (refer to the LIC 9102-TA form).

An exit interview was conducted with David, to whom a copy of this report, the LIC9102-TA, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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