<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604503
Report Date: 08/10/2022
Date Signed: 08/10/2022 01:37:02 PM

Document Has Been Signed on 08/10/2022 01:37 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:
08/10/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Regina Jackson-Patton, Administrator TIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Vicky Williamson, and County of San Diego Nurse Elizar Perez, conducted an on-site visit. LPA and Nurse identified themselves and discussed the purpose of the visit with Regina Jackson-Patton, Administrator.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, Regina Jackson-Patton, was interviewed and a walk-though of the facility was conducted. A debriefing was conducted with Regina Jackson-Patton, Administrator, at the conclusion of the visit. No deficiencies were issued today.

An exit interview was conducted with the Administrator and a copy of this report, along with the Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1