<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881006
Report Date: 08/24/2021
Date Signed: 08/25/2021 01:07:25 PM

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: 5DATE:
08/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Heather Ramirez, LicenseeTIME COMPLETED:
11:10 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Deborah Mullen conducted an announced case management visit to follow up on the licensees request to increase the facilities hospice waiver from four to six residents. LPA met with Heather Ramirez, Licensee.

During the visit LPA inspected the home and observed the home to have six bedrooms and three bathrooms. The fire clearance is approved for 6 non-ambulatory and 1 bedridden resident. Bedroom #2 is for the one bedridden resident. Currently the licensee has seven caregivers to provide 24 hour coverage. The licensee schedules two caregivers from 10am to 6pm. LPA discussed the licensees responsibility to provide additional caregivers as needed for hospice residents.

Nothing further is needed at this time. An exit interview was conducted and a copy of this report was reviewed with and provided to Ms. Ramirez.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1