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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881093
Report Date: 02/18/2021
Date Signed: 02/18/2021 11:24:41 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 MS29-26
RIVERSIDE, CA 92507
FACILITY NAME:REGENT RESIDENTIAL CARE, THEFACILITY NUMBER:
331881093
ADMINISTRATOR:OCAMPO, SHANEFACILITY TYPE:
740
ADDRESS:24939 SUNSET VISTA AVENUETELEPHONE:
(951) 775-0959
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 0DATE:
02/18/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shane Campo and Josephine CaprazTIME COMPLETED:
10:30 PM
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On 2/18/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced pre-licensing video conference inspection to the facility due to COVID-19. LPA met with Shane Campo and Josephine Capraz. Currently there are no residents in care. The application is for a six (6) bed, Residential Care Facility for the Elderly (RCFE) with six (6) residents being non-ambulatory.

All bedrooms are furnished with a 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. The water temperature appeared to be within range. The smoke and carbon monoxide alarms were tested and are in operating order. LPA observed fire doors to be properly functioning. Fire extinguishers are present in the facility and fully charged. The kitchen was observed to have dishes, silverware, pots, and pans. Knives/sharps are inaccessible. Staff and resident files and medication will be locked in a cabinet. A complete first aid kit was observed. The chemicals will be locked and kept inaccessible to residents. The backyard was observed to be fully fenced in with an unlocked gate, a covered patio, table and chairs for residents comfort while sitting outside. No bodies of water was observed. The phone number designated for the facility is (951)723-2348. There are emergency exits, free of obstruction. The fire inspection was conducted and approved.

The facility was evaluated in accordance with the CCR, Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. The facility appears to be ready for licensure.

An exit interview was conducted, and a copy of this report was reviewed and provided to Shane Campo and Josephine Capraz via email to obtain signature.
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte HenryTELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021
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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