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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604796
Report Date: 05/01/2024
Date Signed: 05/02/2024 02:28:24 PM


Document Has Been Signed on 05/02/2024 02:28 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:EL CAJON ELDER CAREFACILITY NUMBER:
374604796
ADMINISTRATOR:SEQUEIRA, JENIFERFACILITY TYPE:
740
ADDRESS:1412 GROVELAND TERRACETELEPHONE:
(619) 541-3179
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:6CENSUS: 5DATE:
05/01/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Applicants Jennifer Sequiera and Nikita DesaiTIME COMPLETED:
04:15 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) Liliana Silveira conducted an announced Pre-Licensing inspection. The inspection included review of Component III, as well as a walk through of 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 at the front entrance by Jennifer Sequeira and Nikita Desai and was granted entry after identifying themselves and disclosing the purpose of the visit.

This is a new facility. The fire clearance was approved on 02/21/24 and reflected that the facility was approved for 6 residents for a Residential Care Facility for the Elderly (RCFE). 5 of the residents may be non-ambulatory and which 1 may be bedridden. As of today's visit, there were 5 residents in care. The submitted facility sketch was consistent the current layout of the facility.

During today’s visit, LPA, accompanied by Jennifer and Nikita conducted an overall inspection of the internal and external areas of the facility. The facility was clean, sanitary and in good repair. Required licensing postings were observed in visible areas of the facility. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. All outdoor and indoor pathways were free from obstruction and slip hazards. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were present and operational. Fire extinguishers were serviced within the last 12 months and affixed with current tags. There is 1 (one) fire extinguisher that is in compliance with regulations. All toxic substances/poisons, chemicals were stored in a locked area inaccessible to residents. Fireplaces, and/or open-faced heaters were inaccessible to residents. (CONTINUED ON NEXT PAGE LIC 809-C)
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/01/2024
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 2


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: EL CAJON ELDER CARE
FACILITY NUMBER: 374604796
VISIT DATE: 05/01/2024
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
26
27
28
29
30
31
32
Resident bedrooms allowed for easy passage with no obstruction and contained the required furnishings. Each window had a screen which was in good condition. The facility has all the required furnishings, linens and personal hygiene items. Resident bedrooms allowed for easy passage with no obstruction and contained the required furnishings.

There are 3 bathrooms for residents to use. Bathrooms are equipped with grab bars and non-skid mats or stickers. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was compliant at 72 degrees F. There were 6 resident bedrooms that measured hot water that are in compliance with regulation.

The facility kitchen was stocked with appropriate cooking items. The facility has locked areas for storage of sharp objects- knives were locked in a secure cabinet which is inaccessible to residents. A seven (7) day supply of non-perishable and two (2) day supply of perishable food items were present. Medications were secured in a locked cabinet which is inaccessible to residents. A first aid kit and manual were present and located in each of the med rooms and the front entrance. Resident and staff files were also in a locked cabinet.

The facility has no pools or bodies of water that were observed on the facility premises. Per Jennifer Sequeira, no firearms or ammunition are or will be stored on the facility premise. LPA discussed continuing operation requirements, record keeping, reporting requirements and physical plant compliance with the applicant. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

The Pre-Licensing and Component III was completed during today’s visit. The applicant was advised that the facility is ready for licensure pending management final review and approval.

An exit interview was conducted with applicant Jennifer Sequiera to whom a copy of this report and Licensee Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The signature below confirms receipt of these documents.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2