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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880671
Report Date: 05/26/2021
Date Signed: 05/26/2021 01:52:46 PM

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:ACCURO HOMES IIFACILITY NUMBER:
331880671
ADMINISTRATOR:VANNOY, LESLEY SIHAVONGFACILITY TYPE:
740
ADDRESS:13172 EARLY CRIMSON STTELEPHONE:
(951) 817-4598
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 6DATE:
05/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:April Lopez, Caregiver
Lesley Vannoy, Administrator		TIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Amy Goldenberg made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived and observed a hand sanitation and sign in station at the entry of the facility. LPA's temperature was measured upon arrival. LPA learned there are six (6) residents residing in the home at this time. There are no cases of COVID-19 within the facility.

The facility has a mitigation plan in place which follows Community Care Licensing guidelines. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions.

Based on the observations made during today’s visit, there are no deficiencies being cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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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