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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880905
Report Date: 04/29/2024
Date Signed: 04/29/2024 04:56:06 PM


Document Has Been Signed on 04/29/2024 04:56 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:TEMECULA MEMORY CAREFACILITY NUMBER:
331880905
ADMINISTRATOR:GEDDIE, JAMESFACILITY TYPE:
740
ADDRESS:44320 CAMPANULA WAYTELEPHONE:
(951) 428-4990
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:64CENSUS: 11DATE:
04/29/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tom OldsTIME COMPLETED:
02:45 PM
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On April 29 2024, an office meeting via teams was conducted regarding the possible closure of the facility. In attendance for the meeting was Regional Manager, Reyna Lacey (RM), Licensing Program Manager (LPM), Tricia Danielson, Licensing Program Analyst (LPA), Sara Martinez, Licensee of GHC OF TEM-RCFE, LLC Tom Olds, General Counsel Marissa Brandel , and Resident Care Director Azizi Baranauskas.

The Department received the facility's Closure Plan. During today's meeting, RM advised on Health and Safety (H&S) code section 1569.682. The Department was advised that notification to the residents, their legal representatives, and Long-Term Care Ombudsman (LTCO) was previously sent. The Department was advised that a copy of the closure plan was submitted to the LTCO. The licensee will provide the date to the Department by May 3, 2024.

The Department was informed the licensee gave notice to the city of the proposed closure and the licensee will provide the date the notice was given to the Department by May 3, 2024. The current residents have placement but not all have scheduled dates to relocate. The licensee anticipates closing by June 30, 2024.

The Department has requested a copy of an updated eviction notice be given to the Regional Office (RO) by May 3, 2024. RM advised visits may occur until closure. Licensee agreed to update the Regional Office as appropriate.

An exit interview was conducted over the phone; where this report was reviewed and provided to Marissa Brandel.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2024
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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