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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881029
Report Date: 01/28/2021
Date Signed: 01/28/2021 02:19:35 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:CARAWAY PLACE ASSISTED LIVINGFACILITY NUMBER:
331881029
ADMINISTRATOR:FORD, CLEOFACILITY TYPE:
740
ADDRESS:33850 CARAWAY PLACETELEPHONE:
(951) 217-8337
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
01/28/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cleo Ford, LicenseeTIME COMPLETED:
02:00 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.This home is currently licensed and in operation with 6 residents under another licensee.

The home is a (6) bedroom, (3) bath home with a living room, dining room, family room and kitchen. Per the approved fire clearance, the licensee is approved for 5 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. Both perishable and non-perishable food was observed and appeared to be sufficient for the number of residents in care. Knives other sharp utensils are locked in a kitchen drawer. Cleaning supplies are locked and stored in cabinets in the hallway. Staff and resident files are locked and kept in a kitchen cabinet. The medications are locked and stored in a kitchen cabinet as well as a first aid kit, which was observed to contain all items required per Title 22 Regulations. The backyard was observed to be fully fenced with an unlocked gate. The back yard has a table and chairs with an umbrella for residents' use. Documents required to be posted in public view were observed to be present.

Based upon today's inspection no corrections are required and the facility is ready to be licensed.

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: 01/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2021
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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