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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880802
Report Date: 11/05/2021
Date Signed: 11/05/2021 01:13:21 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:MURRIETA GARDENSFACILITY NUMBER:
331880802
ADMINISTRATOR:NIARE FEASTERFACILITY TYPE:
740
ADDRESS:24200 MONROE AVETELEPHONE:
(951) 600-7676
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:72CENSUS: 46DATE:
11/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Amy Vaca, Administrative AssistantTIME COMPLETED:
01:20 PM
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Prior to LPAs visit, LPA completed the Covid-19 risk assessment with Receptionist Nicole Almonte. Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Amy Vaca, Administrative Assistant. The Executive Director, Niare was unavailable at the time of LPAs visit, due to being at an off site appointment. LPA explained the purpose of the visit. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer). Staff were also observed wearing appropriate face coverings (surgical masks).
The facility completes daily temperature checks, two (2) times a day which assist with monitoring residents regularly for any changes in condition. Should there be any changes or Covid-19 related symptoms with any resident(s), the facility will contact the resident's physician and responsible party. All facility staff are responsible for cleaning and disinfecting the highly touched surfaces multiple times throughout their shift.

A technical advisory (not a deficiency) was issued, as at the time of LPAs visit a copy of the mitigation plan LIC 808 was requested to be reviewed. There was not one available, because it has not been completed. The Executive Director Niare whom was contacted via telephone agreed to submit the LIC 808 no later 5pm on Tuesday 11/9/21.

An exit interview was conducted, and a copy of this report was provided to Amy Vaca, Administrative Assistant.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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