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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800160
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:37:14 PM


Document Has Been Signed on 10/03/2023 03:37 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:HIGHGATE SENIOR LIVING-TEMECULAFACILITY NUMBER:
331800160
ADMINISTRATOR:WILLIAMS, KATHLEENFACILITY TYPE:
740
ADDRESS:42301 MORAGA ROADTELEPHONE:
(951) 308-1885
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:99CENSUS: 90DATE:
10/03/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Community Resources Manager, Lyssa IraniTIME COMPLETED:
03:45 PM
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On 10/3/2023, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct a health and safety visit at the facility to follow up on a fire that took place at the facility on 10/2/2023. LPA met with Community Resources Manager, Lyssa Irani and Maintenance Manager, Daryl Wilkes who were informed of the purpose of the visit.

LPA was informed that on 10/2/2023, at approximately 11:30 p.m., there was a fire that ignited in the kitchen. Facility staff contacted the local fire department for assistance. Southern California Edison (SCE) also arrived at the facility to inspect the affected area. SCE determined the fire was not caused by electricity or an electrical fault. The kitchen area was not occupied by residents or staff when the fire started, and there were no injuries to residents or staff reported. The fire department reported the fire sprinkler system at the facility was immediately activated, and the water from the fire sprinklers extinguished the fire. During the visit, LPA inspected the kitchen area and observed a kitchen wall and ceiling tiles to be burned. LPA was informed the facility discarded some food supply that was saturated from the fire sprinkler water. The facility is in the process of replenishing the food supply that perished. The facility anticipates reopening the kitchen on 10/9/2023. A written meal plan will be submitted to LPA by close of business today.

Based on Fire Safety Specialist Lorri Larson's inspection, there are only cosmetic damages to the kitchen wall and ceiling as a result of the fire. The kitchen will remain closed until repairs are made and approval is obtained from Fire Safety Specialist Larson. CRM Irani has notified resident's responsible parties of the incident.

During today's visit, LPA did not observe any immediate health and safety concerns. A copy of this report was reviewed and provided to CRM Irani.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023
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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