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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800083
Report Date: 12/29/2021
Date Signed: 12/29/2021 12:51:46 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:RENAISSANCE VILLAGE MURRIETAFACILITY NUMBER:
331800083
ADMINISTRATOR:BRIAN TAUBEFACILITY TYPE:
740
ADDRESS:24271 JACKSON AVENUETELEPHONE:
(951) 319-8243
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:166CENSUS: 72DATE:
12/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Executive Director Brian TaubeTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA met with Executive Director Brian Taube and explained the purpose of the visit. The facility currently has zero positive or suspected Covid-19 cases. As a precaution there is one resident whom is fully vaccinated and received their booster that is in isolation, due to being exposed at a Christmas party that they attended. Thus far they have tested negative and are not exhibiting any symptom's of the virus.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer). Staff were also observed wearing appropriate face coverings (surgical masks).

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The facility will contact the resident's physician should there be event of any COVID-19 related illnesses. Per the facility's mitigation plan submitted in 07/26/21, there is a designated infection control lead that is responsible for monitoring the facility's PPE supply, as well as updating staff and residents pertaining to COVID-19.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to Executive Director, Brian Taube.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021
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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