<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880627
Report Date: 08/29/2023
Date Signed: 08/29/2023 11:52:19 AM

Document Has Been Signed on 08/29/2023 11:52 AM - 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:MAGELLAN RESIDENTIAL CARE INCFACILITY NUMBER:
331880627
ADMINISTRATOR:TAYLOR, WALTERFACILITY TYPE:
735
ADDRESS:2851 MAGELLAN LNTELEPHONE:
(951) 238-1008
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 4CENSUS: 1DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Walter Taylor, LicenseeTIME COMPLETED:
12:00 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 made an unannounced visit to the facility for the purpose of an annual inspection. LPA was greeted by Licensee, Walter Taylor and explained the purpose of the visit. A tour of the facility was conducted inside and out. Licensee informed LPA that current census is one (1) client.

The facility is a five (5) bedroom three and one half (3 1/2) bathroom two story home.

During the tour the following was observed: Clients bedrooms had the required furnishings and was observed to be in good condition. Bathrooms had required signage, hand rails, non-slip mats. Night-lights were observed in the hallways. Fixtures and furniture for an operational facility are present and in good repair. All passageways were free of obstructions, charged fire extinguishers and the fire alarm system was operable, medications are kept centralized and locked, hazardous items are kept inaccessible clients. Hot water was tested at 111.5 degrees Fahrenheit. Backyard area is free from obstructions.
Kitchen/Food Service: LPA observed the entire kitchen, food is stored properly and dishes are clean and in good condition. There is a sufficient supply of perishable and non-perishable foods. Area was observed to be clean and functional.
Administration: Emergency exiting plans, telephone numbers and Ombudsman information and other required signage are posted throughout the facility. Drills are conducted quarterly. The last drill was conducted 08/21/2023.
Record Review and Client/Staff Files: LPA reviewed current staff and all staff have has Criminal Background Clearance, current CPR/First Aid certification, and trainings are current. Client records were reviewed and contained required documents. IPP and Physician reports are current. LPA was informed the client works part time and no longer receives P&I. Client has his own bank account and manages funds himself.
Medication Review: LPA reviewed medication and medication log. Client's medications are being dispensed according to physician's orders.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview conducted and a copy of this report was provided to Licensee, Walter Taylor.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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 1