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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600742
Report Date: 01/29/2025
Date Signed: 01/30/2025 01:21:28 PM

Document Has Been Signed on 01/30/2025 01:21 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:DSC-LAKESIDE HOUSEFACILITY NUMBER:
374600742
ADMINISTRATOR/
DIRECTOR:		MELISSA STEFFENHAGENFACILITY TYPE:
735
ADDRESS:9275 WESTHILL ROADTELEPHONE:
6194607333
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 6CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:House Manager Skye HamptonTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Required Annual Inspection. LPA was greeted and allowed entry into the facility by Caregiver Deliliah Barajas whom LPA discussed the purpose of the visit. A short time later House Manager Skye Hampton and Administrator Kristen Hollobaugh joined the 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, all six (6) clients in care where present.



LPA, accompanied by the Caregiver Barajas, 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. Personal Protective Equipment (PPE) was present. The facility's Corporate office also houses a bulk stock of PPE. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 75 degrees Fahrenheit. The last fire drill was conducted on November 12, 2024. Hot water temperature measured at 116.8 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 is inoperable and screened.. Medications were delivered by a pharmacy in bubble packs, labeled as required, and stored in a locked cabinet. The facility uses the electronic MAR for documentation of administration.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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-LAKESIDE HOUSE
FACILITY NUMBER: 374600742
VISIT DATE: 01/29/2025
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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 telephones were all working. Fire extinguisher(s) were last serviced on March 14, 2024. 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 House Manager Hampton and Administrator Hollobaugh, 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: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
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