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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880644
Report Date: 02/24/2026
Date Signed: 02/24/2026 02:52:15 PM

Document Has Been Signed on 02/24/2026 02:52 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:CRENSHAW TOWN AND COUNTRY GUEST HOME 1 LLCFACILITY NUMBER:
331880644
ADMINISTRATOR/
DIRECTOR:		REAVES, ARTAGOFACILITY TYPE:
735
ADDRESS:2346 FIREBRAND AVETELEPHONE:
(909) 475-9075
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 4CENSUS: 2DATE:
02/24/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Artago ReavesTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 2/24/26, Licensing Program Analysts (LPAs) Kyle Wellington and Jacqueline Shaw-Ross made an unannounced visit to the facility to conduct an annual inspection. LPAs were greeted at the door by the Administrator (Admin), Artago Reeves, who was informed of the purpose of the visit. LPAs observed one (1) staff and no residents present at the facility. The census at the facility is two (2) residents. LPAs received resident and staff paperwork & documentation from the Admin. LPAs toured the inside and outside of the facility with the Admin. LPAs conducted an observation and record review at the facility for the inspection.

Facility Overview: The facility is a one story house with two (2) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, kitchen, living room, dining room, laundry room and attached garage. There are no pools or firearms at the facility. The facility has a fire clearance to serve four (4) ambulatory residents.

Infection Control: LPAs observed soap dispensers in the bathrooms and hand sanitizers in the house. Cleaning supplies were locked in a cabinet in the laundry room and available for regular facility maintenance. LPAs reviewed the facility’s infection control plan which met the department’s requirements.

Physical Plant: LPAs observed the inside and outside of the facility to be clean, safe and well-kept. The floors, windows and doors were clean and well maintained. The halls were free of obstruction and had night lights. The common areas’ fixtures and furniture were in good repair. The residents’ bedrooms were neat, tidy and had the required bedding, furniture and lighting. Bathrooms were clean, orderly and contained handrails and non-slip mats in the shower. The hot water temperature in the bathroom was measured at 105.5 F. Additional clean linens and towels were available in a hall cabinet. The laundry equipment was in good working condition. Laundry supplies were kept in a locked cabinet in the laundry room inaccessible to residents. The one (1) fire extinguishers were charged and tested on 2/4/26 within the last year. Admin

NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Kyle Wellington
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2026
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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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)
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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: 02/24/2026
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tested three (3) individual smoke and carbon monoxide detectors and LPAs found them to be working. The backyard was clean, free of hazards and contained outdoor furniture and shaded area for the residents.

Kitchen/Food Service: LPAs observed the kitchen to be clean, organized, and well maintained. The kitchen had the ability to prepare and store food in a safe and clean environment. Kitchen equipment was in good working condition and functional. Dishes and silverware were clean and in good condition. The refrigerator/freezer was clean, stocked and at the required temperatures. Food in the refrigerator and pantry/cabinets were stored properly and was not expired. The facility has met the department’s requirement to have at least a two day supply of perishable foods and a seven day supply of non perishable foods. All sharp and dangerous objects were kept in a locked cabinet inaccessible to residents. Cleaning supplies were kept in a locked cabinet in the laundry room inaccessible to residents.

Care & Supervision: LPAs observed the facility had sufficient staff present to supervise the residents.

Administration: LPAs observed a facility sketch for the house near the kitchen. Admin holds a current Administrator Certificate expiring on 11/24/27 and a curent CPR Certification expiring on 9/23/26. Admin has a criminal record clearance.

Record Review and Resident/Staff Files: LPAs compared the staff present at the facility and on the staff roster to the Guardian staff roster for criminal record clearance. LPAs reviewed the records of two (2) staff files and two (2) residents’ files. The files contained all the required documentation and paperwork. The staff files possessed a criminal record clearance, and the required training and CPR Certifications were up to date. The residents’ files contained a current physician’s report and signed admission agreement. The staff and residents’ files were kept in a locked cabinet inaccessible to residents.

Health Related Services/Incidental Medical Services: LPAs observed all residents’ medications were locked in a cabinet located in the dining room inaccessible to residents. LPAs reviewed and compared two (2) resident’s medication to the facility’s medication log to make sure all medication was accounted for and was being dispensed according to their physician’s orders. First Aid kit contained all the required items and was kept in a locked cabinet.


NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Kyle Wellington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 02/24/2026
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Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan. The plan was current and up to date. Safety and fire drills are conducted every month with the last drill occurring in February 2026. LPAs observed all facility exits were clear of obstructions and had required signage.

No deficiencies were cited during this visit.

Exit interview was conducted with the Administrator and a copy of this report was given to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Kyle Wellington
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2026
LIC809 (FAS) - (06/04)
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