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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800100
Report Date: 06/10/2021
Date Signed: 09/21/2021 02:23:45 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:GENEROUS HOMECAREFACILITY NUMBER:
331800100
ADMINISTRATOR:LIBED, MARIE ANTONETTEFACILITY TYPE:
740
ADDRESS:31963 GOLDEN WILLOW COURTTELEPHONE:
(951) 467-0366
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:6CENSUS: 3DATE:
06/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Marie LibedTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct an unannounced annual inspection. LPA Prieto met with administrator Marie Libed and toured facility inside and out. Outside area was clean and free of hazardous items. Outdoor area has a shaded area and room for clients to sit. Facility has a census of three (3) clients and the home was clean and free from odors. The kitchen was clean and had enough supplies of perishables and non-perishable to feed the clients in care. Facility is a one story home with seven (7) bedrooms and 3 bathrooms. All bedrooms were found to be clean and free from odors.

Staff records show staff present (3) at facility working at facility at time of visit to be fingerprint cleared and the administrator Libed with a current administrative certificate. Client records are updated and found to be in order.

Facility is following proper procedures for COVID washing etiquette and temperature checks. COVID posting are posted in the facility. Cleaning supplies are stored in a locked and secured area.

LPA Prieto discussed the summary of today's inspection with administrator. LPA Prieto and administrator Libed both signed this report and a copy of this report was left with administrator Libed.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021
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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