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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800064
Report Date: 09/02/2021
Date Signed: 09/02/2021 12:47:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SACRED HEART-STOYVIEWFACILITY NUMBER:
331800064
ADMINISTRATOR:MACIAS, EVELYNFACILITY TYPE:
740
ADDRESS:37189 STOYVIEW CIRCLETELEPHONE:
(951) 698-4258
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
09/02/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Bruce Smerker, LicenseeTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Deborah Mullen conducted an announced visit to the facility to complete an annual inspection with an emphasis on infection control. The LPA, met by Licensee, Bruce Smerker. Currently the facility does not have any residents in placement and is not operating.

During today's visit, the LPA inspected the facility. The home is a two story home with 4 bedrooms downstairs and one upstairs and has three bathrooms. Currently the facility do not have staff employed but if/when the operation resumes the administrator would be designated as the infection control lead person who would be tasked with tracking all COVID-19 cases and/or suspected cases, and ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, that staff are trained in the proper use and disposal of PPE and overall infection control.

The facility has not submitted a Mitigation Plan but per Mr. Smerker a plan will be submitted within 30 days from today's date. Mr. Smerker was provided the LIC number for the Mitgation Plan, (LIC 808). He was also advised that when/if the facility resumes operation, the facility will need to comply with current policies and procedures related to infection control.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Mr. Smerker.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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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