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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800070
Report Date: 06/19/2023
Date Signed: 06/19/2023 11:02:13 AM


Document Has Been Signed on 06/19/2023 11:02 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:BRANDIE'S HOMEFACILITY NUMBER:
331800070
ADMINISTRATOR:JACKSON, BRANDIEFACILITY TYPE:
735
ADDRESS:19416 ELDORADO ROADTELEPHONE:
(951) 776-1901
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:4CENSUS: 4DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Brandie JacksonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Janette Romero conducted an unannounced annual required visit to the facility at 10:00 a.m. LPA was greeted and granted entry by Licensee Brandie Jackson who was informed of the purpose of the visit. Licensee has a current Administrator’s Certificate, which expires on 9/12/2023. During the visit, there was one (1) client at day program and there three (3) clients, and one (1) staff present.

The facility is made up of a two-story home with four (4) client bedrooms, one (1) bathroom, family room, dining area, kitchen, and an attached garage. LPA conducted a tour of the interior and exterior, and reviewed facility documents. LPA observed the following:

Bedrooms: Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting.

Bathrooms: Client bathroom has a working toilet, wash basins, and was equipped with a grab bar and non slip mat in the shower. The facility has clean towels, blankets, and linen, available in different colors for each client. LPA tested the water temperature in client bathroom, which measured at 108-degrees Fahrenheit.

Kitchen: LPA observed a sufficient supply of dishes, glasses, utensils, pots, and pans. Refrigerator and freezer were in working condition and stove is operational. LPA observed sufficient perishable and non-perishable food available for all clients in care. A fire extinguisher was charged and mounted near the kitchen. Sharps and knives are secured with a lock in a kitchen cabinet.

Laundry: Laundry area had a washer and dryer. Cleaning solutions are secured in the locked laundry room, upstairs.
Continued on LIC809-C..
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRANDIE'S HOME
FACILITY NUMBER: 331800070
VISIT DATE: 06/19/2023
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Centrally Stored Medications: LPA observed a first aid kit with required components. Resident medications are locked in a cabinet in the staff office.

Living/Family room: The family room had a working television. Let-Us-No poster, emergency phone numbers, and facility sketch were posted in the family room area.



Yard/Outside Area: Shaded outside seating is available for the clients. A brick wall and fence secured the entire backyard. All outdoor pathways were free of obstructions. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises.

There were no deficiencies noted at the time of the visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Licensee Jackson.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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