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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881097
Report Date: 06/16/2022
Date Signed: 06/16/2022 12:34:25 PM

Document Has Been Signed on 06/16/2022 12:34 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:ABC 2 ,LLCFACILITY NUMBER:
331881097
ADMINISTRATOR:PROTHRO, ESTERFACILITY TYPE:
735
ADDRESS:25320 IVORY AVETELEPHONE:
(951) 442-5952
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 3CENSUS: 0DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ester Prothro, AdministratorTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA), Stephanie Torres, made an announced visit to the facility to conduct an annual inspection, with an emphasis on infection control. The LPA met with Licensee, Ester Prothro, and informed her of the purpose of her visit. There are no clients in care at this time.

During today's visit, the LPA toured the home and made observations pertaining to the facility's infection control measures. The LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report that is pending submittal. The facility has a plan in place to ensure staff are trained in COVID-19 policies and PPE donning/doffing once clients are admitted to the facility.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, Chapter 1 or 6 of the California Code of Regulations. An exit interview to review this report was conducted with Prothro and a copy of this report was provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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