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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800078
Report Date: 10/27/2022
Date Signed: 10/27/2022 04:28:55 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/27/2022 04:28 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BLESSED CAREFACILITY NUMBER:
331800078
ADMINISTRATOR:GURAU, JOHNFACILITY TYPE:
740
ADDRESS:6810 CORONADO WAYTELEPHONE:
(951) 786-0106
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 6CENSUS: 0DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:58 PM
MET WITH:Staff, Magdalina GurauTIME COMPLETED:
04:35 PM
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Licensing Program Analysts (LPA) Janira Arreola and Venus Mixson, made an unannounced visit to the facility in order to do an annual visit with a focus on infection control. LPAs met with Magdalina Gurau who was informed of the purpose of the visit. The staff member came form facility Blessed Elder Care Inc. from down the street to open the home for LPA's.

The facility is licensed for 6 residents, but currently have no residents in care. LPA conducted a walk through of the facility interior and exterior of the facility. LPA observed the facility is a one story, (5) bedroom and (4) bathroom facility. LPA walked through the dining room, the kitchen, the bedrooms, bathrooms, and the living room. LPA walked through the backyard as well. LPA was informed by staff that this facility does not have residents and is currently being used for the licensee and their family.

LPA observed no deficiencies during the time of the visit. An exit interview was conducted were this report was reviewed and provided to staff, Magdalina Gurau.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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