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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603762
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:28:39 PM

Document Has Been Signed on 12/16/2024 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:MOM'S HOUSEFACILITY NUMBER:
374603762
ADMINISTRATOR/
DIRECTOR:		MCINTYRE, CARMEN ROSAFACILITY TYPE:
740
ADDRESS:8596 ATLAS VIEW DRIVETELEPHONE:
(619) 562-5370
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 6CENSUS: 4DATE:
12/16/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee Carmen McIntyreTIME VISIT/
INSPECTION COMPLETED:
12:44 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced continuation visit of the annual inspection on December 16, 2024. LPA Correia met with Licensee McIntyre, identified herself, was granted entrance into the facility, and explained the purpose of the visit.

LPA Correia, accompanied by Licensee McIntyre, toured the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal and hot water temperature (71- and- 117.4 degrees Fahrenheit, respectively) were with-in Licensing guidelines.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons accessible to clients. Medications were stored in locked areas.

[CONTINUED ON LIC 809C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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: MOM'S HOUSE
FACILITY NUMBER: 374603762
VISIT DATE: 12/13/2024
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[CONTINUED FROM LIC 809]

No pools or bodies of water were observed on the premises. Per the Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and the facility landline were all working. Fire extinguishers were in compliance. First aid kit and manual were readily accessible. Administrator’s certification was current as well as the facility’s liability insurance. LPA observed required postings at the facility.

No deficiencies were cited during today's inspection. An exit interview was conducted with Licensee McIntyre to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) will be provided at the conclusion of the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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