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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880896
Report Date: 06/11/2020
Date Signed: 07/15/2020 09:24:26 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:EXCEL ASSISTED LIVING 2FACILITY NUMBER:
331880896
ADMINISTRATOR:ANGELES, PAOLOFACILITY TYPE:
740
ADDRESS:37774 RUSHING WIND ROADTELEPHONE:
(760) 884-6112
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
06/11/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Paolo AngelesTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kathleen Wiggins conducted an announced pre-licensing video conference inspection to the facility due to COVID-19. LPA met with Paolo Angeles. Currently there are 0 residents in care.

The home is a five (5) bedroom, two (2) bath home with a living room, dining room and kitchen. Per the approved fire clearance, the licensee is approved for 5 non- ambulatory and 1 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 water temperature was tested and measured at 115.8 degrees Fahrenheit. The smoke and carbon monoxide alarms were tested and are in operating order. LPA observed fire doors to be properly functioning. Fire extinguishers are present in the facility and fully charged. The kitchen was observed to have dishes, silverware, pots, and pans. Knives are locked in a drawer in the kitchen area area. Staff and resident files will be locked in a file cabinet, in the hall closet. The medications will be locked in cabinet located in the hall closet. A complete first aid kit was observed and to be complete. The chemicals will be locked and kept in the laundry area and locked under the kitchen sink. The backyard was observed to be fully fenced with an unlocked gate and has an umbrella with table and chairs for client’s comfort while sitting outside.


An exit interview was conducted, and a copy of this report was reviewed and provided to Mr. Angeles via email to obtain signature.

Receipt of report was confirmed.
SUPERVISOR'S NAME: Leslie MendivelesTELEPHONE: (951) 248-2222
LICENSING EVALUATOR NAME: Kathleen WigginsTELEPHONE: (951) 205-7142
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
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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