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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880627
Report Date: 08/05/2024
Date Signed: 08/05/2024 09:39:49 AM

Document Has Been Signed on 08/05/2024 09:39 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MAGELLAN RESIDENTIAL CARE INCFACILITY NUMBER:
331880627
ADMINISTRATOR/
DIRECTOR:
TAYLOR, WALTERFACILITY TYPE:
735
ADDRESS:2851 MAGELLAN LNTELEPHONE:
(951) 238-1008
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 4CENSUS: 1DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:50 AM
MET WITH:ADMINISTRATOR, WALTER TAYLORTIME VISIT/
INSPECTION COMPLETED:
09:48 AM
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On August 05, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with Administrator, Walter Taylor. The facility file review was conducted in the Regional Office and additional documents were reviewed on site. The facility is licensed for four Adults and is currently operating at a census of one Adult (735).

LPA Mixson toured the facility along with Administrator and made observations following is a summary of today’s visit. LPA inspected the facility inside and outside, there were no obstructions or debris to the indoor or outdoor passageways currently. The facility is a two-story home located at 2851 Magellan LN, Perris, CA 92571.

Physical Plant: The facility phone number is (951) 238-1008 and it is operable. LPA observed residents’ bedroom, and it was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something" and the "Personal Rights." The cleaning supplies and sharp items were kept locked and inaccessible to the resident in care. There was a designated storage space for the residents' and staff files, and it was locked and inaccessible to resident in care currently at the time of this visit.

Medications: Were locked and inaccessible to resident in care, and there was a sufficient supply of medications. The overall facility is clean, the furniture is in good condition. The facility cooling system and other appliances were operable currently at the time of this visit, and there were safety lights for night throughout the facility.

Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked.

Care & Supervision: Facility has sufficient staff, one staff on site at the time of this visit, and one resident who is off from work today.

Records Review: LPA Mixson reviewed one resident file and two staff files, conducted two staff interviews and one resident interview. Previous Community Care Licensing forms were reviewed. There was no Title 22, Division 6 Regulation violations observed or cited during today’s visit.

An exit interview was conducted, and a copy of this report was discussed and given to Administrator, Walter Taylor.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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