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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880973
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:51:11 AM

Document Has Been Signed on 10/06/2023 11:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:WE THREE CARE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
331880973
ADMINISTRATOR:TRUSS, ANGELFACILITY TYPE:
735
ADDRESS:4175 NICK STREETTELEPHONE:
(714) 866-9537
CITY:RIVERSIDESTATE: CAZIP CODE:
92501
CAPACITY: 4CENSUS: 3DATE:
10/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ambra Williams, House ManagerTIME COMPLETED:
12:00 PM
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On 10/06/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by House Manager, Ambra William who was informed of the purpose of visit. At the time of visit there was 1 staff and 0 residents present. LPA toured the facility inside and out with Ambra William.

Tour included:

Kitchen; LPA toured the kitchen and observed food is stored in a safe and healthful manner. Utensils and dishware are sufficient. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash can has tight-fitting lid. Dishwasher are used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 38 degrees Fahrenheit and Freezer was measures at -2 degrees Fahrenheit.

Dining and Livingroom; LPA toured the dinning and Livingroom area and observed area to be clean and furnitures in good condition. Temperature was 76 degrees Fahrenheit.



Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medications were labeled and stored in separate bins inside of a locked medication cabinet and are distributed according to physician orders. The first aid kit was complete.



Continue on LIC809-C
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WE THREE CARE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 331880973
VISIT DATE: 10/06/2023
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Continued from LIC809.

Bathroom; LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 117 degrees Fahrenheit

Bedroom; LPA toured four #4 out of #4 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility. Resident #1 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 117 degrees Fahrenheit.

Laundry and Garage; LPA tour the garage and observed garage to be clean and not cluttered. LPA observed washing machine and dryer in the garage are all in good repair and sufficient for approved capacity. Cleaning supplies are stored away in the garage and under the kitchen sink inaccessible to clients.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents.

Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and three #3 residents' records were reviewed. All required postings were posted near the entryway and throughout the facility. The administrator certificate expired on 6/4/2023, Ambra informed LPA that the administrator certificate renewal packet has been submitted. LPA spoke to Licensee, Angel Truss via telephone about the annual fee. LPA also gave Licensee PIN to pay online.

Interview; One #1 staff present was interviewed.

Based on the observations made during today’s visit, no deficiencies were noted. An exit interview was conducted, and a copy of this report was reviewed and provided to Ambra William.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC809 (FAS) - (06/04)
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