<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604371
Report Date: 03/07/2023
Date Signed: 03/07/2023 02:22:47 PM


Document Has Been Signed on 03/07/2023 02:22 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LEXINGTON HOUSEFACILITY NUMBER:
374604371
ADMINISTRATOR:ASOY-DANIEL, ROSHELLE HANFACILITY TYPE:
740
ADDRESS:180 W. LEXINGTON AVE.TELEPHONE:
(619) 401-7528
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 6DATE:
03/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Arceli SongcoTIME COMPLETED:
02:30 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) Tammer de los Santos visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility by Caregiver Megan Bragg to whom LPA disclosed the purpose of the visit. Administrator Arceli Songco joined later.

LPA conducted a tour of the facility. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains, and paint throughout the facility, were observed in good condition. Each room intended for resident use had the appropriate furniture, bedding, and appropriate lighting. The linen storage cabinet was observed with a week’s supply of linen and towels. Administrator stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 123 degrees F in the kitchen. Administrator adjusted the temperature to comply with regulation. The ambient temperature inside the facility was measured at 65 degrees F. Caregiver adjusted the temperature to 68 degrees F. The refrigerator and freezer were observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions and knives were properly secured.

A medicine cabinet, located near the kitchen area was observed to be locked, A complete First Aid kit was also available. Client medicine boxes were individually labeled.

No deficiencies were cited during today’s visit. An exit interview was conducted with Administrator Arceli Songco, and copies of this report and Licensee Rights (LIC 9058) were provided at the conclusion of the visit. Facility representative’s signature on this form acknowledges receipt of the rights and a copy of the report.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Tammer DeLosSantosTELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3