331800083-1-15-2026-18-AS-VFLS-DQCQM3-20260115111651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800083
Report Date: 01/15/2026
Date Signed: 01/15/2026 11:18:10 AM

Document Has Been Signed on 01/15/2026 11:18 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:	RENAISSANCE VILLAGE MURRIETA		FACILITY NUMBER:	331800083
ADMINISTRATOR/ DIRECTOR:	BRIAN TAUBE		FACILITY TYPE:	740
ADDRESS:	24271 JACKSON AVENUE		TELEPHONE:	(951) 319-8243
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY: 166		CENSUS: 94	DATE:	01/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Area Director of Operations Jonetta Eads		TIME VISIT/ INSPECTION COMPLETED:	11:28 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/15/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced 1-year required visit. LPA met with Area Director of Operations, Jonetta Eads, and explained to Jonetta the purpose of the visit. LPA conducted a tour of the facility alongside Jonetta and observed the following: The facility is a four-story structure that has a designated activity area, fitness room, formal dining room, and more. During the visit, LPA toured randomly selected resident apartment style units. Resident bedrooms were observed to have the required bedding, furniture, seating, and functional lighting. Each resident units had it's own private bathroom. The selected bathrooms were observed to be in operating condition. Shower areas were observed to be equipped with the required grab bars and slip resistant materials. Water temperature was measured and determined to meet within regulation standards. The facility maintained a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. LPA observed a locked medication room for residents who require assistance with medication management. The facility maintains a fully stocked first-aid kit. LPA observed an outdoor shaded area that was fully furnished. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. LPA observed several carbon monoxide alarms throughout the facility. Indoor and outdoor passageways were observed to be free from obstruction. Facility maintained a clean and odor-free environment. Per Jonetta, there are no firearms and/or ammunition on the premises. LPA observed the required postings of the emergency disaster plan, see something say something, LTCO information, and more. (Continue to LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RENAISSANCE VILLAGE MURRIETA	FACILITY NUMBER: 331800083
	VISIT DATE: 01/15/2026

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(Continuation of LIC809)

Resident records reviewed conducted included but not limited to signed admission agreements, pre-placement appraisals, needs and service plans, medical assessments, identification and emergency information, and personal rights. Staff records review conducted included but not limited to signed job descriptions, criminal record clearance, SOC341A, valid first-aid/CPR Certification, and relevant training's. During the visit, LPA did not observe any health and safety concerns.

An exit interview was conducted and a copy of this report was provided to Jonetta.

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/15/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026

LIC809 (FAS) - (06/04)

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