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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604895
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:01:13 PM

Document Has Been Signed on 03/12/2025 05:01 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MELROSE 48FACILITY NUMBER:
374604895
ADMINISTRATOR/
DIRECTOR:		MENDOZA, JUSTINFACILITY TYPE:
740
ADDRESS:14548 GARDEN RDTELEPHONE:
(702) 776-0689
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 0DATE:
03/12/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:04 PM
MET WITH:Arceli Songco, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:24 PM
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Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 10/10/2024. The facility was approved to care for six (6) Elderly Residents; six (6) Non-Ambulatory and six (6) hospice. LPA was greeted and allowed entry into the facility by and met with Arceli Songco, Administrator

Structure- The facility is a single story structure with 7 bedrooms and 4 bathrooms, 3 of which will be used for resident and 1 staff. There is an outdoor covered area for resident use. No bodies of water were observed.


Bedrooms Residents- Rooms #1, #2, #3, #4, #5 and #6 for Non-Ambulatory one (1) for staff
Bedrooms Staff- staff are using Room #7
Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats. The bathroom next door to the room is used only by staff.
Linens & Hygiene Supplies- Adequate supply.
Emergency Phone Numbers, Exit Plan and Required Postings- Posted.
Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired.
Appliances- Stove burners, oven, microwave, washer, and dryer working.
Toxins- Stored in a locked cabinet.
Water Temperature- Measured at 105- 109.4 degrees F.
Medications- Centrally stored and locked in a cabinet.
First-Aid Kit- Stored in a locked cabinet.
Resident & Staff Files- Located cabinet.
Activities- Adequate supplies to include games and puzzles for resident's use.
Fire clearance- Approved on 12/13/24. Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance.


All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Arceli Songco, Administrator signature below confirms receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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