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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881106
Report Date: 06/22/2023
Date Signed: 06/22/2023 06:18:25 PM


Document Has Been Signed on 06/22/2023 06:18 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:WELLQUEST OF MENIFEE LAKESFACILITY NUMBER:
331881106
ADMINISTRATOR:EADS, JONETTAFACILITY TYPE:
740
ADDRESS:29914 ANTELOPE RDTELEPHONE:
(951) 550-0500
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:140CENSUS: 127DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:ADMINISTRATOR, JONETTA EADSTIME COMPLETED:
06:25 PM
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On June 22, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with the Administrator, introduced self, and stated the purpose of the visit. LPA Mixson toured the facility and inspected the inside and outside of the facility. The facility is a three story building located at 29914 Antelope RD, Menifee, CA. 92584
Physical Plant: The physical plant, two years old and is in good condition, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of this visit. The facility community rooms have the required furniture; such as tables, chairs, storage space, and sufficient lighting. The building temperatures throughout was set to 76. All activity rooms were equipped with the required items for the activities that were posted. The kitchen just had their inspection and tested the hot water temperature in which they each tested as required for regulations. The restrooms were equipped with liquid soap and paper towels. LPA Mixson toured the kitchen and staff were preparing the evening meal. The facility had activity schedules posted and available for review. The Facility has emergency food and water. LPA Mixson inspected the common areas. Smoke detectors are hard wired and were tested recently by the assigned company. The fire extinguishers was in the green and are a maintenance schedule. The carbon monoxide alarms, along with smoke detectors were observed. There was a locked and centralized storage area for medications. Medications are contained in bubble packs. The facility has a designated area for resident and staff files, and it was locked. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent areas. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed monthly activity calendars. LPA Mixson reviewed five staff files, ten resident files, and conducted three staff interviews and two resident interviews. There were no regulation violations observed during todays visit.
An exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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