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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800197
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:08:33 PM

Document Has Been Signed on 02/27/2024 02:08 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:PLEASANT TRAILS RESIDENTIALFACILITY NUMBER:
331800197
ADMINISTRATOR:WALKER, KEITHFACILITY TYPE:
735
ADDRESS:955 PAINTBRUSH TRAILTELEPHONE:
(951) 312-1751
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 4CENSUS: 4DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:House Manager, Brian WalkerTIME COMPLETED:
02:15 PM
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On 2/27/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with House Manager (HM), Brian Walker who was informed of the purpose of the visit. During the visit, there was one (1) staff and LPA was informed that clients were at day program.

LPA toured the facility’s interior and exterior with HM Walker. The facility is made up of a one-story home with four (4) client bedrooms and two (2) client bathrooms. The facility has a fire clearance for four (4) ambulatory clients and serves adults ages 18 through 59. HM Walker tested the smoke alarm/carbon monoxide detectors and LPA found them to be operational. The fire extinguishers were serviced on 2/1/2024. The home is clean and the physical plant is in good condition. There are no bodies of water on the premises. Indoor and outdoor passageways are free of obstruction. Food was stored in a safe and healthful manner. The facility met Departmental requirements for a 2-day supply of perishable food and 7-day supply of non-perishable food items. LPA observed emergency food, water, and four (4) client backpacks with emergency essentials. Medications are secured in a file cabinet in the staff office and disinfectants are secured in a locked hallway closet. The fireplace has appropriate barrier to make it inaccessible for clients. LPA observed board games available for client use. The facility safeguards clients' cash resources. LPA reviewed the clients' Record of Client's/Resident's Safeguarded Cash Resources (LIC405) along with their physical monies and did not observe any discrepancies. LPA reviewed the clients' Medication Administration Records along with their physical medications and did not observe any discrepancies. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where a copy of this report was reviewed and provided to HM Walker.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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