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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604503
Report Date: 03/10/2022
Date Signed: 03/10/2022 05:33:34 PM

Document Has Been Signed on 03/10/2022 05:33 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MORNINGSIDE MANORFACILITY NUMBER:
374604503
ADMINISTRATOR:HULSEY, JOSEFINAFACILITY TYPE:
740
ADDRESS:2847 MORNINGSIDE ST.TELEPHONE:
(760) 481-8238
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 6CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Joseph Li, ApplicantTIME COMPLETED:
01:44 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA was met and granted entry by Joseph Li, Applicant. Josefina Hulsey was also present during the visit.
The facility fire clearance was granted on 12/14/2021 and reflects that the facility is approved for four (4) ambulatory, one (1) non-ambulatory, and one (1) bedridden residents; however, the facility currently has four (4) residents who are non-ambulatory.
During today's visit, LPA, accompanied by Joseph Li and Josefina Hulsey, toured the facility inside and outside. The facility was found to be in good repair with no pathway obstructions. Residents' bedrooms were observed to be clean and contained required furnishings. Toilets were found to be in working order. Facility temperature was 71 - 73 degrees F during the visit. Water temperature in bathrooms used by residents measured at 121.6 and 138.6 degrees F. LPA observed locked cabinets in the kitchen and storage areas in which hazardous and/or toxic chemicals were stored and secured. There were locked cabinets for storage of medications and resident and staff records. There was also a first aid kit present in the facility. Activities and sufficient space in which to conduct activities were present. Two fire extinguishers were observed in the facility. Smoke and carbon monoxide detectors were present and had been recently inspected by the San Diego Fire Department. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition were present or will be stored in the facility. Sufficient and appropriate storage was present to store perishable and non-perishable food items. A seven day supply of non-perishable and two day supply of perishable food items were present for resident use. Required postings were present and will be posted in visible areas of the facility.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MORNINGSIDE MANOR
FACILITY NUMBER: 374604503
VISIT DATE: 03/10/2022
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 Items reviewed during today's visit are not in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and the applicant's approved fire clearance, and applicant has not passed the pre-licensing inspection. Component III was completed during today’s visit. Applicant was advised that the application will require further review and a follow-up visit. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC 9058) will be provided, via email, following the visit.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
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