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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800197
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:22:28 PM

Document Has Been Signed on 02/20/2025 12:22 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/
DIRECTOR:
WALKER, KEITHFACILITY TYPE:
735
ADDRESS:955 PAINTBRUSH TRAILTELEPHONE:
(951) 312-1751
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 4CENSUS: 3DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee-Keith WalkerTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 02/20/25 Licensing Program Analyst (LPA) Debbie Palacios conducted an unannounced one (1) year required visit. LPA was granted entry by Licensee Keith Walker, who was informed of the purpose of visit. Licensee Keith informed LPA that the clients were at the Day Program; no clients were present at the time of the visit. Lead Caretaker Cheyenne Huey came to the facility minutes after. Staff present was observed to have obtained proper fingerprint clearance and were associated to the facility. LPA Palacios observed the following during today's visit:

LPA Palacios conducted a tour of the facility with Licensee Keith. The physical plant is a single story structure that contained four (4) resident bedrooms, one (1) staff bedroom, and one (1) office room; two (2) client bathrooms and one (1) staff bathroom. The facility has a (1) formal dining rooms, kitchen, living room, staff office, garage, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable food and seven (7) day supply of non-perishable foods. There were two (2) refrigerators observed in the garage that were observed to be fully stocked. Knives and sharp items were observed in a locked cabinet in the kitchen. Client's bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. Centrally stored medication was observed in a locked cabinet in the office room. Two (2) fully charged fire extinguishers were observed in the facility dated 02/1/25. The living room was observed to have board games and other activities. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests.

Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Client files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted on a wall in the living room.


SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 RESIDENTIAL
FACILITY NUMBER: 331800197
VISIT DATE: 02/20/2025
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During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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