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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800160
Report Date: 12/30/2022
Date Signed: 12/30/2022 10:48:15 AM


Document Has Been Signed on 12/30/2022 10:48 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: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: 96DATE:
12/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kathleen Williams, Executive DirectorTIME COMPLETED:
10:55 AM
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On December 30,2022, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced case management visit to follow up on the Incident Report received on December 22,2022 regarding a resident’s unauthorized checks that was cashed. LPA met with Executive Director, Kathleen Williams and explained the purpose of the visit.

During the today's visit, LPA Nwogene toured the facility, interviewed residents, reviewed staff file and collected copies pertinent documents. No deficiency was cited during today’s visit.

An exit interview was conducted were this report and LIC811 was discussed with and provided to Kathleen Williams.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2022
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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