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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880913
Report Date: 09/01/2022
Date Signed: 09/01/2022 11:09:17 AM

Document Has Been Signed on 09/01/2022 11:09 AM - 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
RIVERSIDE, CA 92507
FACILITY NAME:SVS MURRIETA CCESFACILITY NUMBER:
331880913
ADMINISTRATOR:WHITAKER, LA RONDAFACILITY TYPE:
775
ADDRESS:39040 SKY CANYON DR SUITE 110TELEPHONE:
(626) 304-1074
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 45CENSUS: 32DATE:
09/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Program Director, Ana GutierrezTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility with the purpose of an annual inspection with focus on infection control. LPA met with Program Director who was informed of the purpose of the visit.

LPA conducted a walk though of the facility and observed client activity rooms, common areas, and restrooms. The facility had (2) isolation room with procedures in place to isolate those with suspected or confirmed cases of COVID-19.

The facility has (3) restrooms available for use for the clients. All (3) restrooms were observed to have hand hygiene supplies such as soap, access to water, and paper towels. All restrooms had hand washing signs as well. The facility also had COVID-19 signs throughout the facility promoting hand washing, masking and social distancing.

LPA reviewed Emergency Disaster Plan, LIC500, and current register of clients. LPA observed that all clients had updated emergency contact information.

LPA observed the facility had one central entry point with screening process for visitors, staff, and clients.

The facility also has a cleaning plan in place to clean and disinfect the highly-touched surfaces.

No deficiencies were noted at the time of the visit.

An exit interview was conduct where this report was reviewed and provided to, Ana Gutierrez
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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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