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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604271
Report Date: 08/06/2020
Date Signed: 08/06/2020 11:06:01 AM

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:SANTEE ELDERLY CAREFACILITY NUMBER:
374604271
ADMINISTRATOR:DERMODY, THOMASFACILITY TYPE:
740
ADDRESS:9069 INVERNESS RDTELEPHONE:
(619) 929-9939
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 6DATE:
08/06/2020
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Tom Dermody TIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jennifer Lott conducted an unannounced Post-Licensing visit via Tele-Visit due to Covid-19 to observe the physical plant and resident records for compliance. LPA identified herself and disclosed the purpose of her telephone call to Licensee, Tom Dermody. An overall inspection of the facility was conducted inside and out. The inspection included but was not limited to:

Physical Plant: Facility temperature was maintained at 77F degrees. LPA did not observe any bodies of water on the premises. Licensee, Dermody advised there are no firearms or ammunition stored on the property. There is one or more carbon monoxide / smoke detector which meets statutory requirements. All outdoor/indoor passageways were free from obstruction. Disinfectants, poisons, cleaning solutions were locked in the garage inaccessible to residents. Water temperature in bathrooms used by residents measured 109.7F degrees for bathroom #1 and 109.8F for bathroom #2. Linens were observed to be clean and in good repair.

Food Service: A one week’s non-perishable food supply is maintained on the property. Perishable food supply is maintained for two days. All food was properly stored and made available to residents.
Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption and First Aid training. Licensee maintains medical assessments and admission agreements with each resident //authorized representative on file. Licensee handles no cash resources. Administrator Certificate is current and will expire on 01/27/2021.

Based on today's visit, no deficiencies were observed at this time in the areas evaluated above. An exit interview was conducted with Licensee, Dermody and a copy of this report along with the Licensee/Appeal Rights (LIC 9058) was provided via email. An electronic read receipt confirms the documents were received.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jennifer LottTELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020
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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