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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604503
Report Date: 09/23/2022
Date Signed: 09/23/2022 05:10:17 PM

Document Has Been Signed on 09/23/2022 05:10 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:REGINA JACKSON-PATTONFACILITY TYPE:
740
ADDRESS:2847 MORNINGSIDE ST.TELEPHONE:
(760) 481-8238
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 6CENSUS: 5DATE:
09/23/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Regina Jackson-Patton, AdministratorTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct a post-licensing visit. LPA was granted entry into the facility and met with Regina Jackson-Patton, Administrator, to whom she disclosed the purpose of the visit.

During today's visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; temperature check initiated at entry for staff, residents, and visitors; a sign-in policy enacted for visitors; signs in the facility to promote hand hygiene, cough/sneeze etiquette, symptom and transmission awareness; hand sanitizer readily available; available visitation area; emergency agencies’ contact information visible to staff; and an ample supply of cleaning products and PPE. Upon LPA's arrival, both staff who were present were observed working without a face covering. Staff 1 (S1) placed a face mask on shortly after LPA's arrival, and Staff 2 (S2) placed a face covering on after being asked to do so by LPA [LIC 811 Confidential Names Listwas provided to identify the staff].

A deficiency is being cited pursuant to Title 22, Division 6, Chapter 8 of the California Code of Regulations on the attached LIC809D. An exit interview was conducted with Regina Jackson-Patton, and copies of this report and Licensee Rights (LIC 9058) were provided to the administrator at the conclusion of the visit. Administrator's signature on this form acknowledges receipt of copies of the rights and the report.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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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Document Has Been Signed on 09/23/2022 05:10 PM - It Cannot Be Edited


Created By: Dawn Segura On 09/23/2022 at 02:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MORNINGSIDE MANOR
FACILITY NUMBER: 374604503

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited

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87468.1 Personal Rights of Residents in All
Facilities: (a) Residents in all residential care
facilities for the elderly shall have all of the
following personal rights: (2) To be accorded
safe, healthful…accommodations . .. This
requirement was not met, as evidenced by:
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Based upon LPA observation, licensee did not accord residents safe and healthful accommodations. This posed a potential health risk to 5 of 5 residents in care.
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that staff will be made aware that disciplinary action may be implemented for future violations of the masking requirement. Copies of the signed statements will be provided to Community Care Licensing by the POC due date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Dawn Segura
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022


LIC809 (FAS) - (06/04)
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