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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881106
Report Date: 04/05/2024
Date Signed: 04/05/2024 10:42:14 AM


Document Has Been Signed on 04/05/2024 10:42 AM - 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: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: 133DATE:
04/05/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Administrator, Jonetta EadsTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted announced visit to the facility in order to conduct a case management, due to increase in capacity. LPA met with Administrator, Jonetta Eads, who was informed of the purpose of the visit.

The licensee is seeking to increase their capacity from 140 to 151 residents.
The facility is a (3) story building/home with 140 bedrooms, and 124 bathroom.
A Fire Clearance was approved on 08/08/2023 for 11 ambulatory, 140 non- ambulatory, 25 of which may be bedridden. LPA reviewed the updated floor plan and conducted a tour of the facility. Facility sketch shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA physically rooms: 228, 237, 205, 247, 262, 236, 328, 230, 231, 325, and 181. LIC500 Staff Roster was verified for sufficient staffing coverage, and LIC610E Emergency and Disaster Plan was reviewed.

No health and safety issues were observed during the time of the visit. The physical plant is ready for increase in capacity. The final approval of capacity increase is contingent upon manager's final review. Licensee will be notified by LPA once capacity increase has been approved by licensing.

An exit interview was conducted where this report was reviewed and provided to, Administrator, Jonetta Eads.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2024
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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