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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881325
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:15:35 AM

Document Has Been Signed on 05/10/2022 11:15 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:A NANA'S LOVEFACILITY NUMBER:
331881325
ADMINISTRATOR:DANFORD-JOHN, KENDRAFACILITY TYPE:
735
ADDRESS:1403 REEDS WAYTELEPHONE:
(951) 224-2800
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY: 4CENSUS: 0DATE:
05/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee- Kendra Danford-JohnTIME COMPLETED:
11:25 AM
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On 05/10/2022 Licensing Program Analyst (LPA) Janira Arreola conducted an announced visit for the purpose of a pre-licensing inspection. LPA met with Licensee, Kendra Danford-John and was granted entry. LPA took a tour of the interior and exterior of the home. The home will be licensed for a total capacity of (4) ambulatory residents, ages 18 through 59.

LPA observed the home as follows: The home is single story 4 bedroom and 2 bathroom home with an attached garage. All fire alarms were tested and in good working condition. Each bathroom had paper towels, soap, and trash cans. LPA advised licensee to post hand washing posters with the hand-washing steps in both bathrooms. All 4 bedrooms have a night stand, reading lamp, bed, and closet space. There were enough linens and extra linens for 4 residents. LPA observed enough personal hygiene supplies including deodorant, shampoo, tooth brushes, toothpaste and body wash. The dining area has 4 chairs, and there is an available outdoor seating area with 4 chairs and a table. The facility does not have a pool or body of water. LPA was informed that no firearms or ammunition will be kept at facility. LPA tested the hot water temperature which was 105.1 degree Fahrenheit. The kitchen has a 7 day supply of non-perishable food and 2-day supply of perishable foods. There is also enough plates, cups, silverware, and cook ware for 4 residents. The facility is stocked with activities to provide entertainment and encourage socialization for the residents, and there is plenty of space for activities both indoors and outside the facility. LPA will give technical advisory for COVID posters to be posted throughout the facility.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2022
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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