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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800173
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:01:39 PM

Document Has Been Signed on 01/22/2025 02:01 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MEGGINSON PLACE IIFACILITY NUMBER:
331800173
ADMINISTRATOR/
DIRECTOR:
RACELIS, JANETTEFACILITY TYPE:
740
ADDRESS:11330 LOMBARDY LANETELEPHONE:
(951) 363-8767
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/22/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Janette Vega Racelis-AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced case management-Health and Safety check at the facility. LPA was greeted and granted entry by Administrator, Janette Vega Racelis and explained the purpose of the visit. At the time of the visit there were three (3) staff and five (5) resident's present. All staff were observed to have obtained criminal record clearance and were associated to the facility. The facility has an approved hospice waiver for four (4) residents. The facility has a total of two(2) residents that are receiving hospice services.

The facility was observed to be operating within the capacity in which it was licensed for. The utilities were observed to be operable and the food supply met the requirements; of a 7 day supply of nonperishable and a 2 day supply of perishable food items. The facility has hygiene supplies, extra linen and Personal Protective Equipment (PPE) supplies located in the garage. Cleaning supplies and personal hygiene products are stored in a locked cabinet in the hallway next to bathroom. The resident's were observed (2 sleeping in the TV room, 1 resident watching TV in the bedroom. ,1 sitting at the table reading) and 1 resident getting clean and changed in the bedroom by caregiver. The resident's medications and sharps were locked and inaccessible to residents.

LPA spoke with administrator regarding any concerns with residents in care and no issues or concerns were reported.

There were no health and safety concerns observed, during today's visit.

An exit interview was conducted, and a copy of this report was provided.
Tricia DanielsonTELEPHONE: (951) -202-5067
Debbie PalaciosTELEPHONE: (951) 248-2222
DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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