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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881365
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:02:40 AM

Document Has Been Signed on 11/10/2022 10:02 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:HARVEST CAREFACILITY NUMBER:
331881365
ADMINISTRATOR:COTTON, MARCUSFACILITY TYPE:
735
ADDRESS:4326 VIA SAN LUISTELEPHONE:
(661) 706-3361
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY: 4CENSUS: 0DATE:
11/10/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Applicant, Marcus CottonTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility in order to conduct a prelicening inspection. LPA met with applicant, Marcus Cotton who was informed of the purpose of the visit.

The facility is doing an initial license with the licensee being Harvest Care LLC, and the Administrator being Marcus Cotton. LPA reviewed administrator qualifications for Cotton and found that all were met. LPA reviewed the pre licensing materials submitted by the applicant such as the facility sketch, emergency disaster plan. LPA observed the store of emergency food, lighting, and (3) first aid kits.

LAP conducted a walk through of the interior and exterior of the facility. LPA observed the home to be (1) story home with (4) bedrooms and (2) bathrooms. The capacity for the facility will be (4) ambulatory with each client having their own room. The fire clearance was reviewed for 9/15/2022 with the Riverside City Fire Department. The bedrooms have all the required furniture, and required hygiene supplies such as tooth paste, tooth brush, body wash, shampoo, and hand soap. LPA observed the hallway lights and the smoke alarms and carbon monoxide detectors were observed to be in good working condition. The facility has (1) fire extinguisher that was inspected and charged. The facility has all the appropriate postings such as personal rights, number to CCIB, and emergency phone numbers. The outdoor area had enough seating for the capacity of (4) with shade and areas indoors were the clients have access to seating and a variety of activities. The kitchen had the required supply of food items. The medications and sharp objects will be kept locked in cabinet in the living room. The hot water temp was observed to be 117F, and there were no bodies of water or fire arms being stored on the premises. The facility phone number (951) 729-5261 was tested and was operational.

Component III was conducted during the time of the visit. No health and safety concerns were observed by the LPA during the visit. The applicant will need to acquire an infrared thermometer for visits as opposed to the tongue thermometer the facility currently has. An exit interview was conducted with Marcus Cotton, and copy of this report was reviewed and provided to him.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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