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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800081
Report Date: 05/16/2024
Date Signed: 05/16/2024 10:30:06 AM


Document Has Been Signed on 05/16/2024 10:30 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:BUSMAN RESIDENTIAL CARE LLCFACILITY NUMBER:
331800081
ADMINISTRATOR:READE, JOHNFACILITY TYPE:
740
ADDRESS:27892 BUSMAN ROADTELEPHONE:
(951) 888-9512
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator, John ReadeTIME COMPLETED:
10:30 AM
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On 5/16/2024, Licensing Program Analysts (LPAs) Janette Romero and Valerie Flores made an unannounced visit at the facility to conduct a required annual inspection. LPAs met with Administrator, John Reade who was informed of the purpose of the visit.

The facility has a fire clearance to care for three (3) ambulatory and two (2) non-ambulatory elderly residents, of which one (1) may be bedridden. LPAs toured the facility's interior and exterior with Administrator Reade.

During the tour, LPAs observed the facility is made up of a two-story home with five (5) resident bedrooms, three (3) bathrooms, a kitchen, living room, and attached garage. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture in the home were observed in good repair along with outdoor furniture and shaded area for residents. Fireplace has appropriate cover and is inaccessible to residents. Administrator Reade tested a smoke alarm/carbon monoxide detector and LPAs found it to be operational. LPAs observed fire extinguishers charged and mounted throughout the facility. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods, with emergency food supplies stored in the garage. Staff present have proper clearance and association to the facility. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were posted in the facility.

During today's visit, no deficiencies were cited. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Reade.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024
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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