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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881446
Report Date: 08/17/2023
Date Signed: 08/17/2023 05:22:47 PM

Document Has Been Signed on 08/17/2023 05:22 PM - 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MAHOGANY HILLS RESIDENCEFACILITY NUMBER:
331881446
ADMINISTRATOR:MANALANSAN, SUZETTEFACILITY TYPE:
735
ADDRESS:30387 REDDING AVETELEPHONE:
(951) 294-0356
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 4CENSUS: DATE:
08/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Applicant Suzette ManalansanTIME COMPLETED:
05:30 PM
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On Thursday, 8/17/2023, Licensing Program Analyst (LPA) Janette Romero conducted an announced visit to the pending facility to conduct a pre-licensing inspection. LPA met with Applicant Suzette Manalansan. Fire clearance has been granted for (4) clients and the facility will serve adults ages 18-59. Applicant Manalansan's administrator certificate expires on 10/6/2024.

LPA conducted of a tour of the facility’s interior and exterior. Facility is made up of four (4) client bedrooms and two (2) client bathrooms along with a kitchen, living/family room, and garage. LPA did not observe bodies of water. The physical plant was in good repair. A brick wall secured the entire backyard. Indoor and outdoor passageways are free of obstructions. LPA observed a charged fire extinguisher, and tested the smoke alarms and carbon monoxide detectors and found them to be operable. Facility has a working telephone. LPA observed a locked area for cleaning solutions, medications, and knives/sharp instruments.

Client bedrooms had the required bedding, furniture, closet storage and lighting. Additional linen and towels are available for clients. LPA toured the kitchen and observed kitchen area to be clean. Refrigerator and stove are operable. Facility had emergency food and water stored in the pantry. Client and staff files will be secured in a file cabinet near the hallway.

Continued on LIC809-C..
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MAHOGANY HILLS RESIDENCE
FACILITY NUMBER: 331881446
VISIT DATE: 08/17/2023
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LPA toured client bathrooms. The hot water temperature in client bathrooms measured at 112- and 114-degrees Fahrenheit.

Emergency disaster plans, personal rights, and complaint procedures were posted in living/family room wall. LPA observed a first aid kit with required components. Living/family room has a working television and adequate seating in common areas.

During today's visit, LPA did not observe any issues or concerns.

Applicant Manalansan has successfully completed Comp II/III. Final approval of licensure will be granted by the Centralized Application Bureau analyst.

An exit interview was conducted where a copy of this report was discussed and provided to Applicant Manalansan.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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