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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604503
Report Date: 12/15/2022
Date Signed: 12/15/2022 02:21:49 PM

Document Has Been Signed on 12/15/2022 02:21 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: 3DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Regina Jackson-PattonTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Case Management visit to observe the physical plant. LPA introduced herself and was granted entry into the facility by Nenita Grande, Staff. Regina Jackson-Patton, Administrator, arrived a short time later, and LPA disclosed the purpose of the visit.

An application for a change in ambulatory status was received by Community Care Licensing on October 5, 2022. A fire clearance for five (5) non-ambulatory and one (1) bedridden was requested, and the fire clearance was approved on October 26, 2022, granting non-ambulatory approval for rooms 1, 2, 3, 4, and 5 and bedridden clearance for room 6. During the visit, LPA toured the facility. No deficiencies were cited during the visit. The Licensee will be notified by Community Care Licensing upon a decision of the application request.

An exit interview was conducted with Regina Jackson-Patton, and copies of this report and Licensee/Appeal Rights were provided to the administrator at the conclusion of the visit. Administrator's signature below confirms receipt of the rights and a copy of this report.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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