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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800083
Report Date: 05/16/2023
Date Signed: 05/16/2023 10:32:46 AM


Document Has Been Signed on 05/16/2023 10:32 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
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: 84DATE:
05/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Executive Director, Brian TaubeTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit on 5/16/2023 at 9:12 a.m. LPA conducted a case management visit for change of capacity for the facility. LPA met with Executive Director, Brian Taube who was informed of the purpose of the visit.

LPA conducted a tour of the facility. LPA observed both fire exit stairs and observed the required evacuation chairs. LPA reviewed the facility's LIC610D on evacuation procedures. LPA observed all the emergency exits were clear of any obstructions.

The property has (4) buildings, Building A, C, D, and E. Building A is a three (3) story building with two (2) emergency stair exits.The facility is seeking to increase their non-ambulatory capacity for the third floor of Building A. LPA reviewed the STD 850 form completed by Murrieta Fire Department on 11/8/2022. The facility was approved for a capacity of 98 non-ambulatory and 14 bedridden, which reflects the capacity of building A. This STD 850 will need to be resubmitted to reflect the entire capacity of the facility comprising all licensed buildings, which should total to the approved (166).

Along with this the facility will need to resubmit:
  • Current number of non-ambulatory and bedridden residents on each floor of the facility
  • Updated floor plan
  • Total number of residents in each building
  • Updated LIC200 to reflect all licensed buildings on the property, not just building A
  • STD850 reflecting delayed egress with correct capacity and previous capacity numbers.


At this time, the facility has not been approved for the increase in non-ambulatory residents.

An exit interview was conducted with Executive Director, Brian Taube. This report was reviewed and provided to them.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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