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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881192
Report Date: 01/23/2025
Date Signed: 01/23/2025 03:29:50 PM

Document Has Been Signed on 01/23/2025 03:29 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BRODIAEA HOUSEFACILITY NUMBER:
331881192
ADMINISTRATOR/
DIRECTOR:		CHARMAINE SIMSFACILITY TYPE:
735
ADDRESS:24595 BRODIAEA AVENUETELEPHONE:
(951) 208-0383
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 4CENSUS: 2DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Staff, WandaWaltersTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Anaylst (LPA) Janira Arreola conducted an unannounced Annual Required Visit. LPA was granted entry by Administrator Melanie Morris and Staff, Wanda Walters who were informed of the purpose of the visit. Wanda Walters assisted LPA with tour and review of facility documents.

The facility is a (1) story home with client rooms totaling (4) bedrooms and (2) bathrooms. There are no bodies of water, weapons or fire arms kept at the facility. LPA conducted a walk through of the facility. The kitchen had the required food supply, sharp objects were kept locked and there were emergency disaster supplies in the pantry. The facility has cleaning supplies locked in a living room cabinet along with hygiene supplies for clients. The medications are kept locked in a hallway closet. The outdoor area was observed to be free of hazards and has an emergency exit. There are activity supplies for clients to engage in. LPA observed the client bedrooms had the required furniture and the bathrooms have grab bars and hygiene supplies for clients. PPE supplies are kept in a locked cabinet in the entry way. The hot water temperature was recorded at 117.8F and the carbon monoxide and smoke alarms are in working condition. The laundry equipment is kept in the dinning area with no accessible cleaning supplies. There is a supply of linens and towels for clients. Required postings are found in the entry way.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRODIAEA HOUSE
FACILITY NUMBER: 331881192
VISIT DATE: 01/23/2025
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The facility has a staff schedule showing staff coverage at all times. There is an Emergency Disaster plan and Infectious Control Plan. Records were reviewed for the current Administrator and staff. The last documented fire drill was conducted 1/14/2025 which met the department requirements. The administrator meets the qualifications and has a current posted Administrator's certificate. (4) additional staff files were reviewed which had the required documents. LPA reviewed both client files which had the required documentation. The clients had current medication records and accounting system for client medications. The client Personal and Incidental funds were reviewed and up to date.

Client and staff interviews where conducted. No health or safety issues were observed or reported during the time of the visit. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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