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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880896
Report Date: 06/11/2021
Date Signed: 06/11/2021 01:04:02 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:EXCEL ASSISTED LIVING 2FACILITY NUMBER:
331880896
ADMINISTRATOR:ANGELES, PAOLOFACILITY TYPE:
740
ADDRESS:37774 RUSHING WIND COURTTELEPHONE:
(951) 239-0126
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 3DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Paolo Angeles, LicenseeTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced annual inspection. LPA met with Paolo Angeles, Licensee.
The home is licensed for 5 non-ambulatory and 1 bedridden resident. The licensee also has a waiver to accept 5 hospice residents.

The home is a five (5) bedroom, two (2) bath home with a living room, dining room and kitchen. 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 kitchen was observed to have dishes, silverware, pots, and pans. Knives are locked in a drawer in the kitchen area. Staff and resident files are locked in a file cabinet, in the hall closet. The medications are locked in cabinet located in the hall closet. The chemicals are 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.

During the visit LPA discussed infection control procedures and practices with Mr. Angeles. The home appeared to be in compliance and no deficiencies were observed or cited.

An exit interview was conducted and a copy of this report was reviewed with and provided to Mr. Angels.
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)
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