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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330911501
Report Date: 12/05/2024
Date Signed: 12/05/2024 11:07:42 AM

Document Has Been Signed on 12/05/2024 11:07 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:WARBLER RCFEFACILITY NUMBER:
330911501
ADMINISTRATOR/
DIRECTOR:		EMMANUEL MANALADFACILITY TYPE:
740
ADDRESS:11661 WARBLER WAYTELEPHONE:
(951) 924-9179
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Cornelia Manalad-CaretakerTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Debbie Palacios conducted an unannounced one (1) year required visit. LPA was granted entry by caregiver, Rex Magnabijon and caregiver Cornelia Manalad , who were informed of the purpose of visit. At the time of the visit there were two (2) staff, and four (4) residents present; one (1) of the residents was getting ready to leave to the Adult Day Program. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA Palacios observed the following during today's visit:

LPA Palacios conducted a tour of the facility with caregiver, Rex and Cornelia. The physical plant is a two- story structure that contained four (4) resident bedrooms, one (1) staff bedroom located on the second floor, and two (2) bathrooms for residents and one (1) bathroom for the staff. The facility has one (1) dining room, kitchen, two (2) living rooms; one (1) in the entrance and one (1) near the kitchen area called the Activity Area, garage, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable food and seven (7) day supply of non-perishable foods. Extra linen were observed in the closet located in the hallway. There were two (2) refrigerators observed; one (1) in the kitchen and one (1) in the garage that were observed to be fully stocked. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items were observed in a locked cabinet in the kitchen; cleaning solutions and disinfectants were locked in the cabinet underneath the sink. LPA also observed the facility has a storage cabinet in the garage filled with additional cleaning solutions, disinfectants, and laundry detergents. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. LPA observed two (2) Fire Extinguishers mounted on the walls dated 06/03/24. Staff member Rex tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational.

Tricia DanielsonTELEPHONE: (951) -202-5067
Debbie PalaciosTELEPHONE: (951) 248-2222
DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WARBLER RCFE
FACILITY NUMBER: 330911501
VISIT DATE: 12/05/2024
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Centrally stored medication was observed in a locked cabinet in the dining area. The outdoor patio was observed to have shaded seating to encourage outdoors socialization. The living room near the kitchen area was observed to have board games and other activities. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests. Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, license and emergency disaster plan is posted on a wall in the kitchen area and in the entrance of the facility.

During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) -202-5067
LICENSING EVALUATOR NAME: Debbie PalaciosTELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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