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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881106
Report Date: 06/29/2021
Date Signed: 06/29/2021 03:11:01 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:WELLQUEST OF MENIFEE LAKESFACILITY NUMBER:
331881106
ADMINISTRATOR:EADS, JONETTAFACILITY TYPE:
740
ADDRESS:29914 ANTELOPE RDTELEPHONE:
(801) 815-0808
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:140CENSUS: 0DATE:
06/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jonetta Eads, Executive DirectorTIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPAs) Deborah Mullen and Jesse Gardner conducted an announced pre-licensing inspection on this date. LPAs met with Jonetta Eads, Executive Director. LPAs conducted an inspection of the facility and the following was observed. The facility has a fire clearance for 140 non-ambulatory residents, of which 25 may be bedridden.

The facility is a two story multi-unit building with 122 apartments. The facility dining room is located on the first floor, along with the conference/activity room. There is a bistro, coffee bar and other gathering areas for residents use. The outdoor court yard has a fenced pool, putting green and bocce ball court for residents. The kitchen was inspected and observed to be appropriately furnished with items necessary to serve the number of residents in care. The facility has the following items posted in public view, per regulations; Long-term Care Ombudsman poster, Community Care Licensing contact information, including the “If you See Something, Say Something” poster, Emergency Evacuation Plan, Lost and Theft Policy, Visitor Policy, and Residents Personal Rights.

LPAs conducted the Component III orientation at the time of the visit.

Based on todays inspection the facility is ready to be licensed.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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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