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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881006
Report Date: 01/06/2021
Date Signed: 01/11/2021 09:14:41 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:CONCORD ESTATES ASSISTED LIVINGFACILITY NUMBER:
331881006
ADMINISTRATOR:RAMIREZ, HEATHERFACILITY TYPE:
740
ADDRESS:31565 FLINTRIDGE WAYTELEPHONE:
(619) 251-8508
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
01/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Heather Ramirez, Administrator/LicenseeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst Deborah Mullen conducted an announced pre-licensing inspection. The inspection was conducted by video due to due to Covid-19 restrictions.

The home is a (6) bedroom, (3) bath home with a living room, dining room and kitchen.
Per the approved fire clearance, the licensee is approved for 4 non-ambulatory and 1 bedridden residents. All bedrooms are furnished with bed, night stand, 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. Fire extinguisher was present and fully charged. The kitchen was observed to have dishes, silverware, pots, and pans. Knives and are locked in the kitchen drawer. Cleaning supplies are locked and stored in the laundry room. Staff and resident files will be locked in cabinet located in the office area. The medications will be stored in a locked medication cart. A complete first aid kit was present and observed to be complete. The backyard was observed to be fully fenced with an unlocked gate and covered patio table with umbrella and chairs for client’s comfort while sitting outside. Documents required to be posted in public view were observed to be present.

During the inspection, LPA Mullen conducted Component III Orientation with Ms. Ramirez.

An exit interview was conducted, and a copy of this report was emailed to Ms. Ramirez for her review and signature.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2021
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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