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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604825
Report Date: 08/29/2024
Date Signed: 08/29/2024 11:59:57 AM

Document Has Been Signed on 08/29/2024 11:59 AM - 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:HARRISON HOMEFACILITY NUMBER:
374604825
ADMINISTRATOR/
DIRECTOR:		GILBO, JACKELINEFACILITY TYPE:
735
ADDRESS:124 HARRISON STTELEPHONE:
(760) 500-8541
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 4CENSUS: 0DATE:
08/29/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Applicant Jackeline GilboTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an announced Pre-Licensing visit. LPA was met by Applicants Jackeline Gilbo, Alex Rodriguez, and Magdalena Patterson and was granted entry into the facility. The purpose of today's visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on 7/22/2024 and the facility is approved for 4 ambulatory clients in the first floor bedrooms only. The facility has two staff bedrooms on the second floor.

During today's visit, LPA toured the facility and inspected every room. The facility was found to be clean, safe, and in good repair with no pathway obstructions. Client bathrooms were observed to be clean and the toilets and showers were found to be in working order. The facility's water temperature was measured at 116.2 degrees Fahrenheit in a private bathroom and 116.8 and 117.1 degrees Fahrenheit in the two common bathrooms. LPA observed locked storage areas where all hazardous and/or toxic chemicals were stored and secured. LPA observed locked storage for client medications and client and staff records. Fire extinguishers were observed throughout the facility and found to be in compliance. A functioning carbon monoxide detector and smoke detectors were observed in the facility. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. LPA observed 7-day supply of non-perishable food. Required postings were observed in a common area of the facility. LPA reviewed facility’s Infection Control Plan and Emergency Disaster Plan.

LPA conducted Component III with the applicants. The topics discussed were continuing operation requirements, record keeping, reporting requirements, and physical plant compliance.

Pre-licensing is complete, and this facility has no deficiencies. It is recommended that this facility be licensed pending final review and approval. An exit interview was conducted with Applicant Jackeline Gilbo, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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