331880644-2-25-2025-18-AS-JARA-DE8PA4-20250225100808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880644
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:08:29 AM

Document Has Been Signed on 02/25/2025 10:08 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	CRENSHAW TOWN AND COUNTRY GUEST HOME 1 LLC		FACILITY NUMBER:	331880644
ADMINISTRATOR/ DIRECTOR:	REAVES, ARTAGO		FACILITY TYPE:	735
ADDRESS:	2346 FIREBRAND AVE		TELEPHONE:	(909) 475-9075
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY: 4		CENSUS: 2	DATE:	02/25/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Licensee and Administrator, Artago Reaves		TIME VISIT/ INSPECTION COMPLETED:	10:10 AM

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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensee and Administrator, Artago Reaves who was informed of the purpose of the visit. At the time of the visit there was (1) staff and no clients were present.

The facility is a one story home with (3) bedrooms and (2) bathrooms with attached garage. No pools or firearms are being kept at the facility. LPA conducted a walk-through, interview, and records review.

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen, hand hygiene supplies, PPE equipment, and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements.

Physical Plant: LPA observed the client bedrooms which were organized and detailed clean. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide were operational, and the hot water temperature read 109F in a client bathroom.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CRENSHAW TOWN AND COUNTRY GUEST HOME 1 LLC	FACILITY NUMBER: 331880644
	VISIT DATE: 02/25/2025

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Care & Supervision/Administration: LPA reviewed the staff scheduled showing adequate staff coverage. The listed administrator possesses a current administrator's certificate.

Record Review and Resident/Staff Files: LPA reviewed (2) staff files which had criminal clearance and updated and required training. (2) client files were reviewed and possessed all required paperwork. The client personal and incidental funds were counted with the assistance of the licensee, and the ledgers were accurate and up to date.

Health Related Services/ Incidental Medical Services: All client medication were locked. LPA reviewed client medications for (2) client and found all medication listed on MARS and accounted for.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 2/1/2025, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the and first aid kit with all required items.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC809 (FAS) - (06/04)

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