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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604385
Report Date: 05/04/2021
Date Signed: 05/04/2021 01:29:22 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 OF SAN MARCOSFACILITY NUMBER:
374604385
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:558 SMILAX RD.TELEPHONE:
(760) 734-5786
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:11CENSUS: 8DATE:
05/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Jim MorrisonTIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPAs) Kennedy and Silveira conducted a Prelicensing/Component III Visit to observe the physical plant for compliance via video calling app due to COVID-19 restrictions with applicant Jim Morrison. The LPAs virtually toured the physical plant and observed resident accommodations including furnishings, linens and personal hygiene items; resident bathroom were equipped with grab bars, bath mats; staff and administrative records are located a the locked office; food service including dishes, utensils, food storage and a seven day supply of nonperishables and a two day supply of fresh perishables are present; toxic substances are stored locked in the garage or the office; medication storage and administration logs are located in a locked cabinet in the kitchen; first aid kit and current first aid manual are located in the office; activities, supplies and sufficient space to conduct are present; fire extinguishers are affixed with a current tag; smoke and carbon monoxide detectors are present and operable; facility posting requirements are present in a common area and the facility administrators certification is current; no pools or other body of water is present on the facility; per the applicant there are no guns, weapons or ammunition located on the property. Discussed with the applicant were continuing operation requirements, record keeping and physical plant compliance. The applicant shall contact the Centralized Application Unit (CAU) for completion of this pending facility application.

An exit interview was conducted with Mr. Morrison, and a copy of this report and Licensee Appeal Rights (LIC 9058) were emailed to Mr. Morrison and a return email acknowledges the receipt of this report.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
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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