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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880905
Report Date: 09/22/2020
Date Signed: 10/21/2020 10:26:54 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:TEMECULA MEMORY CAREFACILITY NUMBER:
331880905
ADMINISTRATOR:GEDDIE, JAMESFACILITY TYPE:
740
ADDRESS:44280 CAMPANULA WAYTELEPHONE:
(714) 241-5600
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:64CENSUS: 0DATE:
09/22/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:James GeddieTIME 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 James Geddie. Currently there are 0 residents in care. The application is for a Residential Care Facility for the Elderly for sixty-four (64) non-ambulatory. The facility was approved for sixty-four (64) Non-Ambulatory Residents. Dementia Plan is on file.

The facility is a 1 story building that consists of 32 bedrooms with baths and six (6) common bathrooms. The inspection consisted of but was not limited to the following: Physical plant; Staff office(s), bedrooms, bathrooms, living room(s), reception area, kitchen, dining area(s), storage closets, laundry rooom, and outside premises.

There are adequate smoke detectors found throughout the facility. Medications and First Aid will be locked in the mediation room. Hot water temperature was measured between 105-120 degrees. Linen supply, furnishing, cleanliness and state of repair, toilets/sinks/showers/tubs were examined. There are chairs, night stands, and reading lamps in each room and there is adequate drawer and closet space for Resident's belongings. The phone number designated for the facility is (951) 428-4990. There is no body of water on premises. There is an emergency exit, free of obstruction, however the perimeter will be secured. The fire inspection was conducted and approved.

The facility was evaluated in accordance with the CCR, Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of clients in care. Facility appears to be ready for licensure.

An exit interview was conducted, and a copy of this report was reviewed and provided to Mr. Geddie 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: 09/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2020
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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