331800117-11-20-2024-56-AS-BSIH-DB7UE8-20241120143042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800117
Report Date: 11/20/2024
Date Signed: 11/20/2024 02:30:49 PM

Document Has Been Signed on 11/20/2024 02:30 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	A PERFECT CHOICE FAMILY HOME		FACILITY NUMBER:	331800117
ADMINISTRATOR/ DIRECTOR:	DAWSON, GARRY		FACILITY TYPE:	740
ADDRESS:	10844 MEADOW CREST CT		TELEPHONE:	(951) 406-1269
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92505
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:56 AM
MET WITH:	Administrator Garry Dawson		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

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LPA Beena Singh arrived at the facility announced to conduct a required comprehensive annual inspection. LPA Beena Singh contacted Administrator Garry Dawson on the phone and Mr. Dawson arrived at the facility.

LPA met with Administrator Garry Dawson, was granted entry to the facility. At the time of the visit, Administrator Garry Dawson reported to LPA Beena Singh that there's no resident at the home.

The facility is a six (6) bedroom, three (3) bathroom home with a kitchen/dining area, living room, and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) non-ambulatory residents and one (1) may be bedridden and currently no residents at the facility. LPA Beena Singh was accompanied by Administrator Garry Dawson to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility will operate in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Beena Singh inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night-stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. Bathroom showers/bathtub have a non-slip mat on the shower floor. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 117 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area.

Efren Malagon	TELEPHONE: (951) 202-6356
Beena Singh	TELEPHONE: (951) 248-2222
	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A PERFECT CHOICE FAMILY HOME	FACILITY NUMBER: 331800117
	VISIT DATE: 11/20/2024

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Cleaning supplies, toxins, sharps, and other dangerous items will be kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet where they will store the resident’s medications and locked in the medicine room area. The facility has first aid kit and a first aid manual.

Food Service: No residents at the facility. Administrator Garry Dawson reported that they will have sufficient Non-perishable and perishable food supply for the number of residents in care, once they will have residents at the facility.

Care & Supervision: The facility has an administrator present that will put sufficient hours to appropriately manage the facility. Administrator Garry Dawson reported to LPA Beena Singh that they will hire enough staff to appropriately provide care and supervision to their residents, once they will have residents at the facility.

Record Review: LPA observed Administrator Garry Dawson updated Administrator Certification and updated First Aid/CPT Certification. No residents’ records to review as there's no resident at the facility.

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 this report (LIC809), was discussed and provided to Administrator Garry Dawson.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Beena Singh	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC809 (FAS) - (06/04)

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