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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604298
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:49:30 PM

Document Has Been Signed on 10/25/2022 03:49 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:MACKENZIE CARE HOMEFACILITY NUMBER:
374604298
ADMINISTRATOR:PREECE, RAQUELFACILITY TYPE:
735
ADDRESS:2487 MACKENZIE CREEK RTELEPHONE:
(619) 752-9851
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY: 4CENSUS: 4DATE:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator, Raquel PreeceTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required 1 - Year Visit. LPA was greeted by Administrator, Raquel Preece, identified herself, and discussed the purpose of the visit.

LPA conducted a tour with Raquel Preece. In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their Infection Control Plan.

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment).

No deficiencies were observed during today's visit. An exit interview was conducted with Administrator, Preece, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
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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