374603946-7-18-2024-08-AS-AROS-D7AUJG-20240718153731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603946
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:37:36 PM

Document Has Been Signed on 07/18/2024 03:37 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:	JACKSON HOUSE		FACILITY NUMBER:	374603946
ADMINISTRATOR/ DIRECTOR:	LINDSAY TAYLOR		FACILITY TYPE:	772
ADDRESS:	5332 JACKSON DRIVE		TELEPHONE:	(619) 303-0933
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY: 15		CENSUS: 10	DATE:	07/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Clinical Director Lindsay Taylor		TIME VISIT/ INSPECTION COMPLETED:	03:50 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. This facility offers short-term acute residential treatment services for individuals diagnosed with mental health issues. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Lindsay Taylor, Clinical Director, to whom LPA discussed the purpose of the visit. The facility serves fifteen (15) short-term Crisis residents; all of whom may be ambulatory.

LPA, accompanied by Clinical Director Lindsay Taylor, 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, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. Hot water temperature at taps for both bathrooms accessible to clients were all compliant.

All kitchen Cooking/dining equipment and utensils are clean and well maintained. A all food is safely stored. . There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

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: JACKSON HOUSE	FACILITY NUMBER: 374603946
	VISIT DATE: 07/18/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

[CONTINUED FROM LIC 809-C]

No pools or bodies of water on the premises. Per Clinical Director Lindsay Taylor, no firearms or ammunition are kept at the facility. signal system is complaint, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid supplies were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients. LPA interviews did not raise any licensing concerns. LPA reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas.Clinical Director Lindsay Taylor presented proof of current/active business liability insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

An exit interview was conducted with Clinical Director Lindsay Taylor to whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2