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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600246
Report Date: 02/15/2023
Date Signed: 02/15/2023 04:08:05 PM

Document Has Been Signed on 02/15/2023 04:08 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MORNING BREEZE HOME IIFACILITY NUMBER:
374600246
ADMINISTRATOR:NELSON C. GARCIAFACILITY TYPE:
735
ADDRESS:5968 ALTAMONT DRIVETELEPHONE:
(619) 475-5147
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 6CENSUS: 3DATE:
02/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator Neil GarciaTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Tammer De Los Santos conducted an unannounced Case Management visit. LPA was allowed entry by Caregivers Conchita Natividad and Joy Dela Resma to whom LPA discussed the purpose of the visit. Administrator Neil Garcia joined later.

Today's visit was in response to self-reported death of Client #1 (C1) [see LIC 811 Confidential Names List for a description of C1]. C1 passed away on February 12, 2023. LPA briefly toured the facility, obtained copies of pertinent client records, and interviewed staff. No deficiencies were cited.

An exit interview was conducted with Administrator Neil Garcia. A copy of this report, Confidential Names List (LIC 811) and Licensee/Appeal Rights (LIC9058) were provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tammer DeLosSantos
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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