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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881414
Report Date: 11/02/2023
Date Signed: 11/02/2023 10:06:53 AM

Document Has Been Signed on 11/02/2023 10:06 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MORENO VALLEY RESOURCE CENTERFACILITY NUMBER:
331881414
ADMINISTRATOR:MARQUEZ, EDUARDOFACILITY TYPE:
775
ADDRESS:22620 GOLDENCREST DR STE D101TELEPHONE:
(951) 247-6077
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 75CENSUS: 0DATE:
11/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Erin StreamTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted announced visit to conduct a prelicensing inspection for a change in location. LPA met with Applicant, Licensee Erin Stream who was informed of the purpose of the visit.

The population that will be served area Adults ages 18 to 59 years of age. The building is a commercial building with office spaces, and one common activity space, two changing rooms, one sick room, and five bathrooms. There are no bodies of water or firearms that will be kept at the facility. The fire clearance was approved for 75 clients.

LPA conducted a tour of the facility. The facility has does not have an outdoor space for clients. Activity spaces and supplies were observed. LPA observed PPE equipment, cleaning supplies, and hygiene supplies for future clients in changing room. LPA observed server room where sharps are being stored.anf medications will be kept locked and inaccessible to clients in LVN office. The facility has three functioning carbon monoxide alarms. First aide kit was observed in the facility kitchen. The facility will provide snacks to program clients which were observed during the time of the visit. The Kitchen was observed to be clean and in good repair.LPA observed area were records will be kept in an office space. Required postings and emergency exits were posted in the facility. Telephone service is operation at (951) 247-6077. Laundry dryer was observed during the time of the visit. Applicant will move washer when new location is licensing as current licensed location washer currently in use.

The applicant may proceed in the prelicensing process. No health or safety concerns were observed during the time of the visit. An exit interview was conducted with Licensee Erin Stream where this report was reviewed and provided to them.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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