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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604353
Report Date: 10/12/2020
Date Signed: 10/13/2020 03:46:49 PM

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:MAJELLA ASSISTED LIVING, LLCFACILITY NUMBER:
374604353
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:2590 MAJELLA RD.TELEPHONE:
(760) 216-6344
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 7DATE:
10/12/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jim Morrison, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Pre-Licensing Virtual Visit, via video conference, due to COVID-19, to observe the facility for compliance with Title 22, Division 6, of California Code of Regulations and Health and Safety Code. The LPA was joined on the call by Jim Morrison, Licensee.

The LPA and facility representative toured the physical plant, and LPA observed the following: resident accommodations, including furnishings, linens, and personal hygiene items; water temperature in the resident bathrooms measured between 109 – 110 degrees F; facility records are stored in a locked cabinet; medications are stored in a locked cabinet; food service, including dishes and food storage were observed; toxic substances are stored in a locked cabinet; a first aid kit is stored in the facility; activities and sufficient space in which to conduct activities are present; fire extinguishers are present; smoke and carbon monoxide detectors are present and operable; required facility postings are present and visible in a common area of the facility. According to the Licensee, there are no guns, weapons, or ammunition stored on the facility property. No swimming pool or body of water was observed on the facility property. Component III was conducted and completed during today’s visit.

Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The Licensee was advised that the application is pending management final review and approval. A copy of this report and Applicant Rights (LIC 9058) were provided to the Licensee via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2020
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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