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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881446
Report Date: 12/10/2024
Date Signed: 12/10/2024 11:32:23 AM

Document Has Been Signed on 12/10/2024 11:32 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:MAHOGANY HILLS RESIDENCEFACILITY NUMBER:
331881446
ADMINISTRATOR/
DIRECTOR:
MANALANSAN, SUZETTEFACILITY TYPE:
735
ADDRESS:30387 REDDING AVETELEPHONE:
(951) 294-0356
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 4CENSUS: 1DATE:
12/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Don AguinaldoTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA),Abdoulaye Zerbo conducted an unannounced visit to the facility for a health an safety check. The LPA met with manager Don Aguinaldo, and informed him of the purpose for the visit and was granted access.

The facility is a single story building and consists of four (4) resident bedrooms, one (1) staff bedroom, and three (3) bathrooms. There is currently one (1) resident in care at the facility.

LPA's case management included interview with management and resident, obtaining pertinent documentation and conducting a tour of the facility for a health and safety check. No health and safety concerns were observed during today's visit. According to the licensee Suzette Manalasan, an internal investigation was conducted. The information received from the in house investigation indicated the SA did not physically abuse the resident in Care. But the licensee was advised by her Consumer Program liaison at IRC to remove SA from the facility. The licensee also stated because of a lack of staff, she was approved to relocate R1 to another facility owned by the same licensee. Her last day at the facility will be December 15th 2024.
Licensee was advised that possible visits and phone interviews will be conducted before a decision is rendered. An exit interview was conducted, and a copy of this report was provided to licensee Suzette Manalasan.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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