331881080-3-12-2025-18-AS-JARA-DEPV48-20250312160554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881080
Report Date: 03/12/2025
Date Signed: 03/12/2025 04:06:35 PM

Document Has Been Signed on 03/12/2025 04:06 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	GUARDIAN ANGELS ADULT RESIDENTIAL CARE		FACILITY NUMBER:	331881080
ADMINISTRATOR/ DIRECTOR:	TUGGLE, DENESICA		FACILITY TYPE:	735
ADDRESS:	26038 HUXLEY DRIVE		TELEPHONE:	(562) 331-4525
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY: 4		CENSUS: 4	DATE:	03/12/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:02 PM
MET WITH:	Licensee, Denesica Tuggle		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with staff and later met by Licensee, Denesica Tuggle who were informed of the purpose of the visit. At the time of the visit there was (3) staff and (4) clients present.

The facility is a one story home with (4) bedrooms and (2) bathrooms with attached garage. No pools or firearms are being kept at the facility.

Infection Control: LPA observed hand washing stations in the facility restrooms and kitchen, hand hygiene supplies and personal hygiene supplies. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility.

Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients in the staff office. The smoke detector and carbon monoxide was operational, and the hot water temperature 120F.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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: GUARDIAN ANGELS ADULT RESIDENTIAL CARE	FACILITY NUMBER: 331881080
	VISIT DATE: 03/12/2025

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Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate.

Record Review and Resident/Staff Files: LPA reviewed (5) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. (4) client files were reviewed, (1) client did not have a signed admission agreement with basic services and rental amount, but had an signed admission policy with facility grievance, eviction and admission criteria. (1) resident had an admission agreement with no rental amount on it. This was documented on a technical advisory note. (1) client recently developed Diabetes and (1) staff is administering glucose tests to the client. The training has not been documented, but has been conducted with the client's medical provider. The licensee was advised to follow the regulations listed in the technical advisory note and document the training for designated staff.

Health Related Services/ Incidental Medical Services: All client medication was locked in the staff office. LPA reviewed client medications for (4) client and found all medication listed on MAR and accounted for.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire drill 2/18/2025, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the and first aid kit.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC809 (FAS) - (06/04)

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