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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800076
Report Date: 04/28/2023
Date Signed: 04/28/2023 09:19:03 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/28/2023 09:19 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SHOWERS OF BLESSINGS HOME 2FACILITY NUMBER:
331800076
ADMINISTRATOR:KIPLEY, BRUCE DFACILITY TYPE:
735
ADDRESS:3910 CASTLEMAN STREETTELEPHONE:
(951) 277-1723
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 6CENSUS: 0DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Bruce D. Kipley, AdministratorTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived to conduct the Annual on April 26, 2023. The black gate door was locked. LPA called telephone numbers on file, an email was sent requesting a call back. There is a white van parked in the front. No sounds coming from the inside. All windows shut.
LPA Delgado received a call back from Administrator Bruce Kipley and there are no clients or staff present in the home.

Licensing Program Analyst (LPA) Yolanda Delgado arrived to the facility and was met by Administrator Bruce Kipley at the door. LPA Delgado introduce herself and explained the purpose of the visit to conduct the Annual Inspection. The facility has been licensed from April 21, 2017 to present, there has been no clients and staff in the facility since April, 2021.

LPA made observation throughout the walk through of the interior and exterior of the facility inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher is charged this year, 01/6/2023. Working utilities and appliances observed. Administrator certificate on file and expires July 19, 2024.

Based on the information received during this visit today, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations.

This LIC 809 was reviewed with the Administrator and a copy will be emailed and a receipt of confirmation will be requested.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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