374604271-5-15-2024-08-AS-DCOA-D5AKXN-20240515081745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604271
Report Date: 05/13/2024
Date Signed: 05/15/2024 08:18:14 AM

Document Has Been Signed on 05/15/2024 08:18 AM - 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:	SANTEE ELDERLY CARE		FACILITY NUMBER:	374604271
ADMINISTRATOR:	DERMODY, THOMAS		FACILITY TYPE:	740
ADDRESS:	9069 INVERNESS RD		TELEPHONE:	(619) 929-9939
CITY:	SANTEE	STATE: CA	ZIP CODE:	92071
CAPACITY:	6	CENSUS: 5	DATE:	05/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Licensee Dermody		TIME COMPLETED:	01:30 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), Debbie Correia, made an unannounced visit to conduct the required One-Year Inspection. LPA Correia was greeted by Licensee Dermody, introduced herself and explained the purpose of the visit. The facility is licensed to serve 6 residents aged 60 and above, six all (6) of whom may be non-ambulatory, three (3) bedridden, and four (4) residents who may be on hospice care. LPA Correia conducted resident records were reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, and Admission Agreement, and personnel records were reviewed for First Aid/CPR certification, Criminal Record Clearance, TB clearance, and Health Screening Report, and required training. The facility carbon monoxide and smoke alarms were last inspected on October 12, 2023. The facilities last disaster drill was conducted on February 25, 2024. LPA Correia, accompanied by Licensee Dermody, conducted a facility tour, and inspected resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Required postings were observed. Resident bedrooms contained the required furnishings, a private bathroom, resident showers were equipped with non-skid flooring and grab bars. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SANTEE ELDERLY CARE	FACILITY NUMBER: 374604271
	VISIT DATE: 05/13/2024

NARRATIVE

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The facility was equipped with emergency lighting, and first-aid kit and manual. Medications were housed in a locked cabinet. Cleaning supplies and other toxins were inaccessible to residents in care. There were no bodies of water on the facility property. The facility had ample space for activities and a large outdoor shaded area. Per Licensee Dermody, there are no firearms or other weapons on the facility premises. The facility had a 7-day supply of non-perishable and a 2-day supply of perishable food. The facility’s ambient internal temperature was compliant, at 75 Fahrenheir. The facility's hot water temperature for faucets used by residents measured at 110.8- and 113.9- degrees Fahrenheit.

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 Dermody, whose signature on this form acknowledges receipt of these documents.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

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