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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604393
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:46:42 PM

Document Has Been Signed on 02/12/2025 02:46 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:WELLSPRING ASSISTED LIVING IIFACILITY NUMBER:
374604393
ADMINISTRATOR/
DIRECTOR:
MCCLURE, WILLIAMFACILITY TYPE:
740
ADDRESS:7010 JACKSON DRIVETELEPHONE:
(619) 884-7227
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY: 6CENSUS: 5DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Jill McClureTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator William McClure and Jill McClure. According to the facility’s license, the facility has a maximum capacity of 6 non-ambulatory residents, one of which may
be bedridden with a hospice waiver for 6.

LPA toured the interior and exterior of the facility and inspected every room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Water temperature was measured at 114 degrees F. The facility does not have any bodies of water.

LPA toured and observed the kitchen. The kitchen was clean, organized and sanitary. Cooking/dining equipment and utensils were present. There was sufficient perishable food and at least two weeks worth of non-perishable food. No sharp objects were accessible to residents.

LPA observed medication and first aids were complete and readily accessible. Medications were labeled, as required, and stored under lock and key. Resident records contained the required documentation. Staff records contained the required documentation. Per Administrator, no firearms or ammunition are kept at the facility.

No deficiencies were cited on todays visit. An exit interview was conducted with Administrator Jill McClure, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to during the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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