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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601648
Report Date: 11/30/2023
Date Signed: 11/30/2023 07:25:39 PM


Document Has Been Signed on 11/30/2023 07:25 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:LAKE MURRAY HEALTH CARE CENTERFACILITY NUMBER:
374601648
ADMINISTRATOR:LOURDES G GONZALESFACILITY TYPE:
740
ADDRESS:7867 LAKE ANDRITA AVENUETELEPHONE:
(619) 464-5640
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:6CENSUS: 6DATE:
11/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee Lourdes GonzalezTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Licensee Lourdes Gonzalez made an unannounced visit to the facility to conduct the required annual licensing inspection. LPA was met by Licensee Lourdes Gonzalez, identified herself, was granted entry into the facility, and stated the purpose of today’s visit, to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. There were 6 residents and 3 staff present during today's visit. LPA Correia conducted a general overall inspection. The facility is licensed to serve 6 residents, age 50 and older, and all of whom may be non-ambulatory.

The facility temperature was 74 degrees Fahrenheit at the time of the visit. The resident’s bathroom's hot water temperature measured 107.4 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to residents. All residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and equipped with the required supplies. Showers had nonskid flooring and grab bars. Lighting was maintained in hallways and passages to residents’ bathrooms.

Licensee Gonzalez provided each resident with clean linen in good repair, and sufficient hygiene products for personal use. LPA Correia observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. Per Licensee Gonzalez there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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: LAKE MURRAY HEALTH CARE CENTER
FACILITY NUMBER: 374601648
VISIT DATE: 11/30/2023
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The facility is stocked with a 2-day supply of perishable and 7-day supply of nonperishable food items. The food was observed properly stored. Medications are stored in a locked cabinet and administered according to the label instructions. The facility's last disaster drill was conducted on August 8, 2023.

Per staff records reviewed, individuals subject to a criminal record review obtained clearance and/or an exemption; staff responsible for direct care and supervision have current First Aid and CPR training. Administrator Certification is current.



Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Licensee Gonzalez and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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