331880575-6-17-2023-18-AS-JROO-CSVTW7-20230617150504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880575
Report Date: 06/17/2023
Date Signed: 06/17/2023 03:05:08 PM

Document Has Been Signed on 06/17/2023 03:05 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	NEW LIFE SENIOR INDEPENDENT LIVING		FACILITY NUMBER:	331880575
ADMINISTRATOR:	WYLIE, EDWARD		FACILITY TYPE:	740
ADDRESS:	25247 CORTE ORANADA		TELEPHONE:	(951) 691-8060
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	3	CENSUS: 1	DATE:	06/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Licensees Michelle Brann and Edward Wylie		TIME COMPLETED:	03:10 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) Janette Romero conducted an unannounced annual required visit to the facility at 1:30 p.m. LPA met with Licensees Michelle Brann and Edward Wylie who were informed of the purpose of the visit. During the visit, there was one (1) resident and the Licensees present. The facility is made up of a two-story home with five (5) bedrooms, three (3) bathrooms, family room, dining area, kitchen, and an attached garage. LPA conducted a tour of the interior and exterior, and reviewed facility documents. Current resident is independent. LPA observed the following: Bedrooms: Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting. Bathrooms: Both bathrooms have a working toilet, wash basin, and were equipped with a grab bar in the shower. The facility has clean towels, blankets, and linen, available in different colors for each client. Kitchen: LPA observed a sufficient supply of dishes, glasses, utensils, pots, and pans. Sample menu is posted on kitchen wall. The stove is operational. Refrigerator and freezer were in working condition. LPA observed sufficient perishable and non-perishable food available for the resident. A fire extinguisher was charged and mounted near the entrance hallway. Sharps and knives are not locked due to the resident being independent. Continued on LIC809-C..

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: NEW LIFE SENIOR INDEPENDENT LIVING	FACILITY NUMBER: 331880575
	VISIT DATE: 06/17/2023

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Laundry: Laundry area had a washer and dryer. Cleaning solutions are secured in a locked cabinet in the upstairs laundry room.

Centrally Stored Medications: LPA observed a first aid kit with required components. Medications are stored in an unlocked box on the kitchen counter top.

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

Yard/Outside Area: Covered patio seating is available for residents. A brick wall secured the entire backyard. All outdoor pathways were free of obstructions. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises.

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 Licensees.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette Romero	TELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2023

LIC809 (FAS) - (06/04)

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