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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600906
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:14:31 PM

Document Has Been Signed on 02/25/2025 10:14 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/
DIRECTOR:
PATRICIA M. WHITEFACILITY TYPE:
735
ADDRESS:12222 WINTER GARDENS DRIVETELEPHONE:
(619) 443-6075
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 3CENSUS: 2DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Licensee Patricia WhiteTIME VISIT/
INSPECTION COMPLETED:
05:20 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 identified herself, discussed the purpose of the visit and conducted a tour of the facility accompanied by Licensee Patricia White.

The facility is licensed to serve three (3) ambulatory clients. During the tour LPA observed 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. Client rooms were equipped with the required furnishings. The facility had sufficient space and supplies for activities and a large outdoor shaded area. The facility's internal ambient temperature and hot water temperature for faucets used by Clients measured with in regulation. Smoke alarms, carbon monoxide detectors, emergency lighting, and the facility telephone were present and operational. First aid kits were complete and readily accessible.


No clients take medications (prescription and PRN), therefore, there were no stored medications or medication records. There were no sharp objects, toxic chemicals/poisons, cleaning supplies, 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 gates to enter the pool were self-latching. Per Licensee Patricia White, no firearms or ammunition are kept at the facility.

Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights (LIC 9058 (rev. 01/16)) will be provided to Licensee White whose signature on this form acknowledges receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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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