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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881014
Report Date: 05/16/2022
Date Signed: 05/16/2022 04:08:39 PM


Document Has Been Signed on 05/16/2022 04:08 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:SIERRA RESIDENTIAL CAREFACILITY NUMBER:
331881014
ADMINISTRATOR:GOFFUR, EFAZFACILITY TYPE:
740
ADDRESS:37182 SIERRA GROVE DRIVETELEPHONE:
(951) 742-1742
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:37 PM
MET WITH:Facility Representative- McClain BergTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA), Janira Arreola conducted an annual inspection at the facility. LPA was greeting and granted entry by Facility representative McClain Berg, who was informed of the purpose of the visit.

LPA toured the facility and observed no residents. The facility is has 6 bedrooms and 4 bathrooms. All bedrooms have furniture such as a bed, desk lamp, chair, nightstand and closet space. All bathrooms are fully stocked with toilet paper, soap, and paper towels. The kitchen was clean and stocked with food, cooking pans and pots, and utensils. The cleaning supplies and sharp objects are being kept in a secure locked location. The living room and dinning area have enough seating for the capacity of the facility which is for (6) residents. The outdoor area is clean and free of hazards and has a shaded seating area for more than (6).

LPA toured the facility on 5/9/2022 for a pre-licensing inspection for facility Betty's Place. McClain Berg is the current applicant of Betty's Place and gave LPA access to the facility. LPA spoke with current Licensee Efaz Goffur who stated that the facility does not currently have residents and was sold. LPA advised Efaz Goffur to close facility Sierra Residential Care.

There were no deficiencies cited at the time of the visit. This report was reviewed and a copy was given to Representative McClain Berg.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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