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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600625
Report Date: 01/15/2025
Date Signed: 01/15/2025 11:57:10 AM

Document Has Been Signed on 01/15/2025 11:57 AM - 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:DSC-MORTON HOUSEFACILITY NUMBER:
374600625
ADMINISTRATOR/
DIRECTOR:		KRISTEN HOLLOBAUGHFACILITY TYPE:
735
ADDRESS:5695 DUGAN AVENUETELEPHONE:
(619) 469-1818
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 6CENSUS: 5DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Nightshift Staff Marina AvilaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, Required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Nightshift Staff Marina Avila. The facility's license shows a maximum capacity of 6 clients, all of which which must ambulatory. During today’s inspection there were 5 residents in care.
 
LPA and Staff Marina A. 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. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink 1 was 108F and bathroom sink 2 read at 115F. Kitchen sink tap read at 115F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking and dining equipment, as well as utensils were present. No toxic chemicals, poisons, or sharps were accessible to clients.

[Continued on LIC 809-C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: DSC-MORTON HOUSE
FACILITY NUMBER: 374600625
VISIT DATE: 01/15/2025
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[Continued from LIC 809]

Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per staff Marina A., no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed two (2) staff and zero (0) clients, and interviews did not reveal any licensing or regulatory concerns. LPA observed that clients in care appeared in good condition and well groomed. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas.

No deficiencies were cited during the inspection. An exit interview was conducted with HR director Rocio Salcedo to whom a copy of this report was provided. Their signature below confirms receipt of this document.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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