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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881313
Report Date: 04/26/2022
Date Signed: 04/26/2022 10:58:28 AM

Document Has Been Signed on 04/26/2022 10:58 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:TEYRENCE ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
331881313
ADMINISTRATOR:MANALANG, RUBENFACILITY TYPE:
735
ADDRESS:1821 FITZGERALD AVENUETELEPHONE:
(951) 487-6828
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 6CENSUS: 5DATE:
04/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Licensee- Loramae AquinoTIME COMPLETED:
11:00 AM
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On 04/26/2022 Licensing Program Analyst (LPA) Janira Arreola conducted an announced visit for the purpose of a pre-licensing inspection. LPA met with Licensee, Loramae Aquino and was granted entry. LPA took a tour of the interior and exterior of the home. The facility went under a change in ownership and currently has 5 clients and is licensed for a total capacity of 6 clients, ages 18 through 59. LPA was informed that no firearms or ammunition being kept at the facility. The Administrator, Ruben Manalang has a current Administrator's Certificate expiring 10/27/2023.


LPA observed the home as follows: The home is single story 5 bedroom and 3 bathrooms home with an attached garage next to the laundry room. There is dining area, kitchen, and a living room. LPA had Licensee test all smoke alarms and Carbon Monoxide alarms, all were in good working condition.LPA observed locked cabinets where sharp objects, medicine, and cleaning supplies were being kept. The facility has a sufficient supply of perishible and non-perishable foods. LPA walked through the garage and yard and did not noitced any health and saftey hazards. Resident rooms possessed a bed, night stand, lamp, and closet space. LPA noticed broken laundry hamper in R1's room and advised Licensee to replace it as soon as possible.

LPA checked clearance for Administrator, Ruben Manalang, upon checking the Guardian system, he was associated to the new facility number 331881313.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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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