331881441-1-29-2026-18-AS-JSRS-DQSP8J-20260129100537

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881441
Report Date: 01/29/2026
Date Signed: 01/29/2026 10:05:45 AM

Document Has Been Signed on 01/29/2026 10:05 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:	WARREN MENIFEE GUEST HOME		FACILITY NUMBER:	331881441
ADMINISTRATOR/ DIRECTOR:	WARREN, GLADYS M.		FACILITY TYPE:	735
ADDRESS:	27962 MERBIE CIRCLE		TELEPHONE:	(909) 975-8115
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92585
CAPACITY: 4		CENSUS: 0	DATE:	01/29/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Gladys Warren, Administrator		TIME VISIT/ INSPECTION COMPLETED:	10:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/29/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted at the door by Gladys Warren, Administrator, and was notified of the purpose of the visit. LPA was allowed entry into the facility to conduct the inspection. The facility is a two story six (6) bedroom, four (4) bathroom home and is comprised of a living room, a family room, kitchen, dining area, laundry room, garage, and a backyard area. The downstairs area of the home is designated for client use and contains two (2) client bedrooms, one full bath with tub and shower, and one half bath. Physical Plant: The Licensee is operating the facility within the conditions and limitations specified on the license. Outdoor and indoor passage ways appear to be clear and free of obstructions with no immediate hazards. No pool or body of water was observed on the property. No weapons or ammunition are kept in the home. Disinfectants, cleaning supplies, and hazardous materials were locked and inaccessible to clients. A comfortable temperature is maintained in the home. There is sufficient lighting in all rooms, furnishing in all rooms are clean and well-maintained. Toilets, hand washing, and bathing facilities were kept safe, sanitary, and in operating condition. Water temperature was tested at 106 degrees. The smoke and carbon monoxide alarms were tested and found to be operable. The facility is odor-free and observed to be clean and safe. Food Service: LPA observed a variety of food which appeared to be selected and stored in a safe and healthful manner. The facility contained the required two-day supply of perishable food items and a seven-supply of nonperishable food items. The kitchen appeared to be clean and odor-free.

NAME OF LICENSING PROGRAM MANAGER: Rikesha Stamps
NAME OF LICENSING PROGRAM ANALYST: Jacqueline Shaw Ross
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WARREN MENIFEE GUEST HOME	FACILITY NUMBER: 331881441
	VISIT DATE: 01/29/2026

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Record Review: LPA reviewed staff records and staff files contained the required training; including but not limited to, first aid training and emergency procedures training. Staff present had the required criminal record clearances. There were no client files to review due to zero (0) census. Administrator Gladys Warren has an active Administrator's certificate which expires on 08/24/2027.

Medication: There were no medication for clients reviewed due to zero (0) census.

No deficiencies were cited at this time. This report was reviewed with Administrator Gladys Warren and a copy was provided.

NAME OF LICENSING PROGRAM MANAGER: Rikesha Stamps
NAME OF LICENSING PROGRAM ANALYST: Jacqueline Shaw Ross
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/29/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2026

LIC809 (FAS) - (06/04)

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