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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881115
Report Date: 07/28/2022
Date Signed: 07/28/2022 02:22:47 PM

Document Has Been Signed on 07/28/2022 02:22 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:ANGEL'S LOVING TOUCHFACILITY NUMBER:
331881115
ADMINISTRATOR:CERDA, YAZMIN S.FACILITY TYPE:
740
ADDRESS:37212 EDGEMONT DRIVETELEPHONE:
(951) 249-9041
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 6CENSUS: 4DATE:
07/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jazmin Cedra - AdministratorTIME COMPLETED:
02:30 PM
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On this date, Licensing Program Analysts (LPAs) Crystal Colvin and Chinwe Nwogene made an unannounced visit to the facility to investigate a complaint #18-AS-20220721143820. During today's inspection, LPA Colvin observed that the laundry room (which stores both medication and chemicals) was unlocked at the time of LPAs visit. Additionally, the medication cart and cabinets containing chemicals were unlocked. It is relevant to note that there is no ability to lock the laundry room door from the outside, so without the cabinets and medication cart being locked, all items were accessible. Deficiency cited.

Based on observations made by LPA Colvin, the facility was cited and deficiency noted on the LIC 809D page. LPA Colvin conducted an exit interview wit Administrator Jazmin Cedra where a copy of this report, LIC 809D, and appeal rights were provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/28/2022 02:22 PM - It Cannot Be Edited


Created By: Crystal Colvin On 07/28/2022 at 01:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGEL'S LOVING TOUCH
FACILITY NUMBER: 331881115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2022
Section Cited
CCR
87309(a)

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Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidenced by:
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Licensee agrees to conduct staff re-training on safe storage of hazardous materials, such as medication and chemicals. Licensee to provide LPA Colvin with proof of staff training by Plan of Correction date of 7/29/22
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The Licensee did not comply with the above regulation with one area of the facility. LPA Colvin observed the medication cart and cabinets containing chemicals in the laundry room to be unlocked and accessible. This is an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Crystal Colvin
LICENSING EVALUATOR SIGNATURE:
DATE: 07/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2022


LIC809 (FAS) - (06/04)
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