374604777-7-2-2024-08-AS-JBAD-D6SW2Q-20240702165444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604777
Report Date: 07/02/2024
Date Signed: 07/02/2024 04:54:57 PM

Document Has Been Signed on 07/02/2024 04:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	RAMONA SENIOR GARDENS		FACILITY NUMBER:	374604777
ADMINISTRATOR:	JAMIL, FAIZAN		FACILITY TYPE:	740
ADDRESS:	1240 H STREET		TELEPHONE:	(858) 663-9200
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	68	CENSUS: 0	DATE:	07/02/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Administrator Faizan Jamil, Licensee Harris Jamil		TIME COMPLETED:	05:00 PM

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Licensing Program Analyst (LPA) Juliana Barfield conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to Administrator Faizan Jamil and Licensee Harris Jamil.

The facility fire clearance was granted on 02/02/2024 and reflected that the facility was approved for sixty-eight (68) residents in total, of which 38 maybe non-ambulatory and 30 residents may be bedridden. The facility's fire clearance did not include endorsements for delayed-egress doors or secured perimeter. The submitted facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA, accompanied by Administrator Faizan Jamil and Licensee Harris Jamil, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Resident bedrooms and hallways allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 72 degrees F. Hot water temperature at taps accessible to residents were also compliant.

The facility has enough linens, cooking and dining supplies, and non-perishable food for future resident use. All kitchen appliances were in working order. Kitchen refrigerator temperature was 40 F, and kitchen freezer temperature was 0 F.

[CONTINUED ON LIC 809-C],

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RAMONA SENIOR GARDENS	FACILITY NUMBER: 374604777
	VISIT DATE: 07/02/2024

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[CONTINUED FROM LIC 809]

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has locked areas for storage of sharp objects, medication, and confidential resident and staff records.
A pool with a locked gate on the perimeter was observed on the premises. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Per the applicant’s representative, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Fire extinguishers were serviced within the last twelve months. A complete first aid kit was present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were compliant with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. Pre-Licensing is complete and this facility has no deficiencies.

LPA also provided the Component III Training during today’s visit. Administrator Faizan Jamil and Licensee Harris Jamil were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with Administrator Faizan Jamil and Licensee Harris Jamil to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024

LIC809 (FAS) - (06/04)

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