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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881450
Report Date: 10/24/2023
Date Signed: 10/24/2023 09:34:40 AM

Document Has Been Signed on 10/24/2023 09:34 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:FIREROCK ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
331881450
ADMINISTRATOR:MARCAIDA, NATALIEFACILITY TYPE:
735
ADDRESS:15538 FIREROCK LANETELEPHONE:
(951) 906-2545
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 4CENSUS: 0DATE:
10/24/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Christopher Eke - LicenseeTIME COMPLETED:
09:43 AM
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Licensing Program Analyst (LPA) Sara Martinez conducted an announced visit to complete the Pre-licensing inspection. LPA met with Licensee Christopher Eke, to complete the initial inspection for an Adult Residential Facility with a capacity of four (4) residents.

The facility is a three (3) bedroom, two (2) bath home. There are three (3) client bedrooms, staff office, kitchen/dining area, one (1) living room area, and a backyard. LPA toured the interior and exterior areas of the facility. The following were inspected:

LPA observed clients bedrooms with the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, lighting, and emergency lighting. Client bathrooms had clean appliances that were operating in safe and sanitary condition and the showers contained non-slip mats and grab bars.

LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. The knives and sharp objects will be locked in a kitchen drawer. Client medications will be locked and in a cabinet located in the kitchen. The facility's hot was temperature was recorded at 118F.

The washer and dryer are located in the laundry room. The laundry detergent and chemicals will be stored and locked in the shed located outside. Client and staff files will be located in cabinets in the staff office. The facility maintains an adequate supply of clean linen and personal hygiene supply. The facility does not have any bodies of water on the property. There is a covered area with seating for the all the clients. All passageways were free from obstruction. LPA observed multiple charged fire extinguishers in the facility. The smoke detectors and carbon monoxide alarms were operational. The facility does not have any firearms and ammunition on the property.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: FIREROCK ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 331881450
VISIT DATE: 10/24/2023
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LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights. LPA observed first aid kits with the required items. The facility has working telephone for client use.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA have determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and this facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Licensee Christopher Eke.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC809 (FAS) - (06/04)
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