331880549-8-18-2026-18-AS-JSRS-DX3QG6-20260818120901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880549
Report Date: 08/18/2026
Date Signed: 08/18/2026 12:09:10 PM

Document Has Been Signed on 08/18/2026 12:09 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:	EXCEL ASSISTED LIVING LLC		FACILITY NUMBER:	331880549
ADMINISTRATOR/ DIRECTOR:	ANGELES, PAOLO		FACILITY TYPE:	740
ADDRESS:	24077 GRAFTON AVE		TELEPHONE:	(951) 239-0716
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY: 6		CENSUS: 5	DATE:	08/18/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Paolo Angeles, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jacqueline Shaw-Ross arrived at the facility to conduct an unannounced annual required visit to the facility. LPA met with Administrator Paolo Angeles who was informed of the purpose of the visit. During the visit, there were five (5) residents, and three (3) staff present. The facility has an approved hospice waiver for six residents. The facility is a one-story home with five (5) resident bedrooms, two (2) bathrooms, family room, dining area, kitchen, and an attached garage. LPA conducted a tour of the interior and exterior, reviewed facility documents and observed the following: Bedrooms: Client bedrooms were each furnished with a bed, chair, closet, clothing storage, lighting, and an operable smoke alarm/carbon monoxide detector, in accordance with Title 22 regulations. Bathrooms: Both bathrooms have a working toilet, wash basin, and were equipped with a grab bar and non-slips mats in the shower. LPA tested water temperatures in resident bathrooms and water temperatures were measured at 110 degrees Fahrenheit. The facility has clean towels, blankets, and linen, available in different colors for each resident. Kitchen: LPA observed a sufficient supply of dishes, glasses, utensils, pots, pans and sample menu is posted on the kitchen wall. The stove is operational and refrigerator and freezer were in working condition. LPA observed sufficient perishable and non-perishable food available for the residents. Laundry: Laundry room was equipped with operable washer and dryer. A fire extinguisher was charged and mounted on laundry room wall. Continued on LIC 809-C....

Jacob Garber
Jacqueline Shaw Ross
	DATE: 08/18/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

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 3

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 3

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: EXCEL ASSISTED LIVING LLC	FACILITY NUMBER: 331880549
	VISIT DATE: 08/18/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Living/Family room: The family room has a working television and board games are available for the residents. Let-Us-No poster, Long- Term Care Ombudsman poster, emergency phone numbers, and facility sketch were posted in the kitchen/family room area.

Review of Resident/Staff Records: LPA reviewed resident records. All documents were up-to-date and contained required documentation. Review of staff records contained up-to-date CPR/Ist Aid certification, background clearances and other required documents. Administrators license is up to date and fees are current.

Medication Record: LPA's review of residents medication revealed medications are documented according to physicians orders and dispensed properly.

Yard/Outside Area: Covered patio seating is available for residents. A brick wall secured the backyard. All outdoor pathways were free of obstructions. There were no bodies of water observed anywhere on the property. There were no firearms or ammunition observed at the facility, and LPA was informed the facility does not store firearms or ammunition on the premises. Fire Drills are conducted quarterly, last drill was conducted in June 2026.

There were no deficiencies noted at the time of the visit. An exit interview was conducted, and a copy of this report was reviewed and provided to facility Administrator, Paolo Angeles.

NAME OF LICENSING PROGRAM MANAGER: Jacob Garber
NAME OF LICENSING PROGRAM ANALYST: Jacqueline Shaw Ross
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/18/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3