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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600906
Report Date: 01/09/2024
Date Signed: 01/28/2024 04:26:48 PM

Document Has Been Signed on 01/28/2024 04:26 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:WHITE, MRS. PATRICIA M.FACILITY NUMBER:
374600906
ADMINISTRATOR:PATRICIA M. WHITEFACILITY TYPE:
735
ADDRESS:12222 WINTER GARDENS DRIVETELEPHONE:
(619) 443-6075
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 3CENSUS: 2DATE:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Patricia WhiteTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself, discussed the purpose of the visit and toured the facility with Licensee Patricia White.

According to the facility’s license, the facility can serve three (3) ambulatory developmentally disabled adults. The facility currently serves two ambulatory developmentally disabled clients. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate meetings and client activities. The facility’s ambient internal temperature was comfortable and compliant, at 68 degrees F. No clients take medications (prescription and PRN), therefore, there were no stored medications or medication records. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. A pool was present at the facility. The pool fence was at least 5 feet high and the fence did not obstruct the pool from view. The gates to enter the pool were self-latching. Per Licensee Patricia White, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. The Fire Extinguisher was serviced within the last 12 months. First aid kits were complete and readily accessible.


LPA interviewed staff and clients, no interviews raised any licensing concerns.

Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Mrs. White, to whom a copy of this report, and the Licensee Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
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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