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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800083
Report Date: 01/25/2023
Date Signed: 01/25/2023 01:50:45 PM


Document Has Been Signed on 01/25/2023 01:50 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:RENAISSANCE VILLAGE MURRIETAFACILITY NUMBER:
331800083
ADMINISTRATOR:BRIAN TAUBEFACILITY TYPE:
740
ADDRESS:24271 JACKSON AVENUETELEPHONE:
(951) 319-8243
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:166CENSUS: 79DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Executive Director, Brian TaubeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit on 01/25/2023 at 12:16 p.m. in order to conduct an annual visit with a focus on infection control. LPA met with Executive Director, Brian Taube who was informed of the purpose of the visit.

LPA proceed to conduct a walk through of the facility'. LPA observed there was a central entry point where screenings are conducted for facility visits. LPA observed COVID-19 postings throughout the facility. The facility has a 30-day supply of PPE equipment that is readily accessible to staff. LPA observed the resident bedrooms that would be used as isolation rooms. The resident bathrooms were observed to be clean and have the appropriate hand hygiene supplies such as hand sanitizer, soap, running water and paper towels.

The facility has a cleaning plan in place to disinfect and clean the high touch surfaces of the facility and the isolation rooms. The staff have leave in case of contact or testing positive for COVID-19. The staff have been trained on how to properly don and doff the PPE equipment, and there is a plan of care in place to attend to those residents that would be in the isolation rooms. The staff have also been FIT tested for an N95 respiratory.

LPA was informed that the facility stopped doing temperature checks for visitors and staff. LPA will document a technical advisory note for facility to continue doing this and advised that temperature do not need to be recorded, but the current guidance is to keep checking temperatures.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where this report was reviewed and provided to Executive Director, Brian Taube.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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