<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880836
Report Date: 06/11/2021
Date Signed: 06/11/2021 11:29:12 AM

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:ALOHA HOME CARE IIIFACILITY NUMBER:
331880836
ADMINISTRATOR:MARTINEZ, IARISH CHRISTIANFACILITY TYPE:
740
ADDRESS:39869 SOUTH CREEK CIRCLETELEPHONE:
(951) 760-2345
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Agnes Martinez, LicenseeTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced annual inspection. LPA met with Agnes Martinez. Currently, there are no residents in placement.

The home is a five (5) bedroom, three (3) bath home with a living room, dining room and kitchen. Per the approved fire clearance, the licensee is approved for six (6) bedridden residents. All bedrooms are furnished with bed, nightstand, dresser and chair. Bedrooms have adequate lighting for residents’ use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The smoke and carbon monoxide alarms were tested and are in operating order. The kitchen was observed to have dishes, silverware, pots, and pans. Knives and cleaning supplies are locked under the kitchen sink. Staff and resident files will be locked in cabinet located in the office area. The medications will be lock in the hall closet. A complete first aid kit was observed in the kitchen cabinet. The chemicals will be locked and kept locked cabinet in the garage. The backyard was observed to be fully fenced with an unlocked gate and covered patio table with umbrella and chairs for client’s comfort while sitting outside.

During the visit LPA reviewed infection control practices and procedures with the Licensee. The facility is in compliance and no deficiencies were cited.

An exit interview was conducted and copy of this report was reviewed with and provided to Ms. Martinez.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1