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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602224
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:09:06 PM

Document Has Been Signed on 10/03/2023 01:09 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:MORNING BREEZE HOME IVFACILITY NUMBER:
374602224
ADMINISTRATOR:EMERITA A. GARCIAFACILITY TYPE:
735
ADDRESS:423 HORIZON VIEW DRTELEPHONE:
(619) 426-6369
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 6CENSUS: 4DATE:
10/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Caregiver Josephine RocamoraTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Josephine Rocamora. LPA also spoke with Licensee Emerita Garcia via phone during the visit.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 09/15/2023), involving Client #1 (C1). [See LIC 811 Confidential Names List for a description of C1].

During today’s visit, LPA performed a brief facility tour and welfare check on other clients in care, finding no immediate safety concerns. (At the time of LPA’s visit, C1 was off-site at their place of employment.) LPA also reviewed pertinent care records and interviewed relevant staff.

No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with Rocamora. A copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensee during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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