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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880849
Report Date: 03/10/2025
Date Signed: 03/10/2025 05:46:26 PM

Document Has Been Signed on 03/10/2025 05:46 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:MARC EWELL ARF HOMEFACILITY NUMBER:
331880849
ADMINISTRATOR/
DIRECTOR:		EWELL, MARCFACILITY TYPE:
735
ADDRESS:35569 CHANTILLY CTTELEPHONE:
(951) 223-3950
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY: 4CENSUS: 4DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:47 PM
MET WITH:Licensee/Administrator Marc EwellTIME VISIT/
INSPECTION COMPLETED:
05:55 PM
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On 03/10/2025 at 03:47 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to conduct the required comprehensive annual inspection. LPA Brown was greeted by a Licensee/Administrator Marc Ewell and gained access at the home. LPA Brown explained the purpose of the visit to Licensee/Administrator Ewell.

The facility has six (6) bedrooms, four (4) and 1/2 bathrooms, kitchen, dining room, living room, laundry room, attached garage, and a backyard. The facility is vendorized by Inland Regional Center (IRC). LPA Brown completed a walkthrough of the facility, review of records, medications audit and Personal & Incidental (P&I) audit.



Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed four (4) clients during the visit. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. LPA Brown inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs, and sufficient lighting. LPA Brown inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperature tested at 110.4 degrees Fahrenheit. The facility is equipped with operational combined smoke detectors and carbon monoxide detectors, charged fire extinguishers, and first aid kit with first aid book.

Posters such as; the personal rights, CCLD complaint poster, labor laws, emergency disaster plan, Visitation Policy, Grievance Procedures, and House Rules were posted in a common area. Client medications were kept in secure cabinet inaccessible to clients. LPA Brown observed no night lights at the hallway leading to clients' shared bathroom located in the first floor of the home. Technical Violation will be issued. The facility had emergency kits, emergency food and water. There are no firearms and ammunition in the facility.
*** Continuation in LIC809C ***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: MARC EWELL ARF HOME
FACILITY NUMBER: 331880849
VISIT DATE: 03/10/2025
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Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the left side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions.

Food Service: LPA observed more than two (2) day(s) supply of perishable food and more than seven (7) day(s) supply of non-perishables food and snacks. Dishes, cups, and utensils were stored properly.


Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: The facility has an updated Infection Control Plan, Emergency Disaster Plan, Liability insurance and Surety Bond. LPA Brown reviewed four (4) client files for admission agreements, medical assessments/physician reports, Individual Program Plan (IPP) and Centrally Stored Medications List/Physician Orders. LPA Brown observed files reviewed were complete. LPA Brown also reviewed staff and administrator's file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed no issues, files reviewed were complete.

LPA Brown audited three (3) clients’ medications and no issues were observed. LPA Brown audited one (1) client P&I and no issue observed.

Technical Violation was issued during this visit. An exit interview was conducted where this report LIC809, and LIC9102 were discussed, and copies were provided to Licensee/Administrator Marc Ewell.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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