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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881194
Report Date: 01/06/2022
Date Signed: 01/06/2022 09:47:29 AM

Document Has Been Signed on 01/06/2022 09:47 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:EHIEMERE RESIDENTIAL CARE HOMESFACILITY NUMBER:
331881194
ADMINISTRATOR:EHIEMERE, CHYKEFACILITY TYPE:
735
ADDRESS:14311 QUINCY STREETTELEPHONE:
(951) 992-9065
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 4CENSUS: 0DATE:
01/06/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Chyke Ehiemere, LicenseeTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection and Comp III. LPA arrived at the facility at 08:50 AM and met with Licensee Chyke Ehiemere. Upon arrival, LPA's temperature was taken, and LPA signed into the facility. Licensee Ehiemere accompanied LPA on a tour of the inside and outside of the facility.

Currently there are no residents in care. The facility is a four bedroom, two bath home with a living room/dining room, and kitchen. Per the approved fire clearance, the licensee is approved for 4 ambulatory residents. All bedrooms are furnished with bed, night stand, dressers and have adequate lighting for residents use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The bathrooms have paper towels and soap for residents in care. The water temperature was tested and measured between 111.7 to 117.2 degrees Fahrenheit. The smoke alarms and carbon monoxide alarm were tested and are in operating order. LPA observed one fire extinguisher present in the hallway adjacent to the kitchen area and fully charged. The kitchen was observed to have dishes, silverware and pots and pans. The knives were stored in a locked cabinet in the kitchen. The medications, were in a locked cabinet in the dining room. The chemicals are locked in the kitchen under the sink. The client files will be stored in the dining area in a locked cabinet. The backyard was observed to be fully fenced with an unlocked gate with adequate shaded area under a patio cover.

LPA found all facility features to be in compliance and in line with Title 22 Regulations.

An exit interview was conducted and a copy of this report was reviewed with and provided to Licensee Chyke Ehiemere.
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2022
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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