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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604353
Report Date: 05/05/2021
Date Signed: 05/06/2021 05:17:30 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: 8DATE:
05/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:39 AM
MET WITH:Juan Carlo Ponce de Leon, House ManagerTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced Health and Safety tele-visit due to COVID-19 concerns. The visit was conducted via video conference application, Cisco Webex, due to COVID-19 restrictions. LPA conducted the virtual call with Juan Carlo Ponce de Leon, House Manager, identified herself and disclosed the purpose of the virtual visit.

During today's visit, LPA virtually toured the facility and observed that the facility is taking precautions to mitigate the spread of COVID-19. Facility staff are following proper protocols upon entry. Log was updated to include visitor temperature check and contact information. Hand washing signs are posted at the sink areas. Staff were wearing their face coverings.

No deficiencies were cited during today’s call.

An exit interview was conducted with Juan Carlo Ponce de Leon, House Manager, via virtual visit, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to Juan Carlo Ponce de Leon, House Manager, and Jim Morrison, Licensee, via electronic mail. An electronic read receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
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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