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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600289
Report Date: 03/26/2025
Date Signed: 03/26/2025 03:36:45 PM

Document Has Been Signed on 03/26/2025 03:36 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:LEMON GROVE TERRACEFACILITY NUMBER:
374600289
ADMINISTRATOR/
DIRECTOR:		CELIA A. MENESESFACILITY TYPE:
740
ADDRESS:8554 CALLE NORTETELEPHONE:
(619) 463-6705
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 6CENSUS: 5DATE:
03/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Celia Meneses, Licensee/Administrator,TIME VISIT/
INSPECTION COMPLETED:
03:45 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) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Celia Meneses, Licensee/Administrator, to whom LPA discussed the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of six (6) elderly residents, (5) five of which can be non-ambulatory. During today’s inspection, four (4) residents were home.

LPA, accompanied by the Administrator, toured the interior and exterior of the facility, and inspected each room. During the visit, LPA checked the water temperature in private and common bathrooms for resident and staff use. In the common bathrooms, the hot water temperature measured at 143.8 and 131.5 degrees Fahrenheit. LPA requested that Administrator Meneses lower the hot water heater and the hot water was later measured at 113.9 and 116.2 degrees Fahrenheit.

LPA observed a front door lock, which utilized a keypad reversed so the keypad is used to exit the facility. The secured screen door key deadbolt was reversed so a key needed to be used to exit the facility. Also, there were pad locks on exterior fence gates. Records review and interviews indicated that a locked perimeter for this facility is not approved by fire clearance. LPA requested the key pad and deadbolt be removed and replaced to reflect Tittle 22 regulations for exiting a facility. LPA also had licensee staff remove pad locks from outside gates.



Therefore, two deficiencies regarding hot water temperature and Locked perimeter are being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. Administrator cleared both deficiencies during the visit, and LPA provided Administrator with a Letter of Deficiencies Cleared.

An exit interview was conducted with Licensee/Administrator Mensese, whose signature below confirms receipt of a copy of this report, the Letter of Deficiencies Cleared, and the Licensee Appeal Rights (LIC9058 3/22).
NAME OF LICENSING PROGRAM MANAGER: Denise Powell
NAME OF LICENSING PROGRAM ANALYST: Amy Rodgers
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 3
Document Has Been Signed on 03/26/2025 03:36 PM - It Cannot Be Edited


Created By: Amy Rodgers On 03/26/2025 at 02:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LEMON GROVE TERRACE
FACILITY NUMBER: 374600289

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(2)
(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements:
(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or perimeter fence gates and that facility staff on all shifts have access to, and know how to use, equipment needed to unlock exterior doors or perimeter fence gates.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
.Based on LPA's observation of (1) one doorway exit and (2) side gates, the licensee did not comply with the section cited above in three (3) of (3) exits which poses an immediate health risk, safety risk to 5 out 5 persons in care.
POC Due Date: 03/27/2025
Plan of Correction
1
2
3
4
 LPA requested that Administrator Palad lower the hot water heater and the hot water was later measured at 113.9 and 116.2 degrees Fahrenheit.
LPA observed a front door lock, which utilized a keypad reversed so the keypad is used to exit the facility. The secured LPA requested the key pad and deadbolt be removed and replaced to reflect Tittle 22 regulations for exiting a facility. LPA also had licensee staff remove pad locks from outside gates.
Type A
Section Cited
CCR
97303(e)(2)
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observations of (2) two of (3) bathrooms facuets tempratures the licensee did not comply with the section cited above in 5 of 5 persons in care which poses an immediate health and safety risk to persons in care.
POC Due Date: 03/27/2025
Plan of Correction
1
2
3
4
 LPA requested that Licensee lower the hot water heater and the hot water was later measured at 113.9 and 116.2 degrees Fahrenheit.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Denise Powell
NAME OF LICENSING PROGRAM MANAGER:
Amy Rodgers
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2025


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