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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604279
Report Date: 02/10/2025
Date Signed: 02/10/2025 03:01:40 PM

Document Has Been Signed on 02/10/2025 03:01 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:UC CARE SENIOR LIVING IIIFACILITY NUMBER:
374604279
ADMINISTRATOR/
DIRECTOR:
DEREK POSADAFACILITY TYPE:
740
ADDRESS:6325 DENNISON STREETTELEPHONE:
(858) 546-2463
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 3DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Flora Kelly and Caregiver Beatriz JimenezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Required Annual Inspection. The LPA introduced herself and disclosed the purpose of the visit to Caregiver Beatriz Jimenez. Administrator Flora Kelly arrived during the visit and assisted the LPA. The facility was licensed for a capacity six (6), approved for six (6) non-ambulatory, of which one (1) may be bedridden, and a hospice waiver for five (5).

LPA, accompanied by caregiver, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

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 toxic chemicals/poisons accessible to residents. Medications were labeled, and stored in locked areas. No pools, nor bodies of water were observed on the premises.

Per staff, no firearms, nor ammunition were kept at the facility. Carbon monoxide detectors, and facility telephone were all working. Fire extinguisher(s) were present. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed multiple staff and client records/files. No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Caregiver Beatriz Jimenez, to whom a copy of this report was provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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