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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604503
Report Date: 07/14/2022
Date Signed: 07/14/2022 05:34:15 PM

Document Has Been Signed on 07/14/2022 05:34 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: 5DATE:
07/14/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Joseph Li, ApplicantTIME COMPLETED:
01:58 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an announced pre-licensing visit to follow-up on a previous pre-licensing visit that was conducted on June 6, 2022 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 granted entry and met with Joseph Li, Applicant, and Regina Patton, Administrator.

The facility fire clearance was granted on May 11, 2022 and reflects that the facility is approved for one (1) ambulatory, four (4) non-ambulatory, and one (1) bedridden residents. During today's visit, LPA toured the facility and observed that facility rooms are being utilized in accordance with the facility sketch that was approved by the local fire inspecting authority.

Item reviewed during today's visit is in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations, and applicant has passed the pre-licensing inspection. Applicant was advised that the application is pending management final review and approval. This report was discussed with the applicant, and copies of the report and Applicant Rights (LIC 9058) were provided to the applicant at the conclusion of the visit. Joseph Li's signature on this report acknowledges receipt of the documents.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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