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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600742
Report Date: 01/09/2024
Date Signed: 01/09/2024 05:41:49 PM

Document Has Been Signed on 01/09/2024 05:41 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:DSC-LAKESIDE HOUSEFACILITY NUMBER:
374600742
ADMINISTRATOR:MELISSA STEFFENHAGENFACILITY TYPE:
735
ADDRESS:9275 WESTHILL ROADTELEPHONE:
(619) 460-7333
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 6CENSUS: 6DATE:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:House Manager Skye HamptonTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by the House Manager Skye Hampton, to whom LPA discussed the purpose of the visit. A short time later Administrator Melissa Steffenhagen arrived to assist with the facility tour/inspection.

According to the facility’s license, the facility has a maximum capacity of six (6) clients all of which are ambulatory. During today’s inspection, there was a total of six (6) clients in care, all of whom are ambulatory.



LPA, accompanied by the Administrator Steffenhagen, 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, as well as Personal Protective Equipment (PPE). The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 76.1 degrees. Hot water temperature measured at 107.6- and 110.3- degrees Fahrenheit at taps accessible to clients.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored and unexpired. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, the fireplace was inaccessible to clients and per Administrator Steffenhagen is never used. Medications were delivered by Ron's Pharmacy in bubble packs and labeled as required and stored in a locked cabinet.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: DSC-LAKESIDE HOUSE
FACILITY NUMBER: 374600742
VISIT DATE: 01/09/2024
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There were no bodies of water on the facility grounds, nor, per the facility Administrator, were any firearms, ammunition, or weapons kept on the premises.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) 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 reviewed staff and client records/files; all required documentation were present. Confidential records were stored in locked areas.

During today's visit no deficiencies were issued. An exit interview was conducted with Administrator Steffenhagen, to whom copies of this report and the Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
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