331881457-2-26-2024-18-AS-YDEO-D2TR4X-20240226114217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881457
Report Date: 02/26/2024
Date Signed: 02/26/2024 11:42:32 AM

Document Has Been Signed on 02/26/2024 11:42 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	GROVE HOUSE LLC		FACILITY NUMBER:	331881457
ADMINISTRATOR:	GROVE, MARISSA		FACILITY TYPE:	735
ADDRESS:	64978 LEONARD CT		TELEPHONE:	(951) 505-8163
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY: 3		CENSUS: 0	DATE:	02/26/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Marissa Grove & Wesley Grove, Licensee		TIME COMPLETED:	11:50 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	Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:10 AM, LPA met with Licensee/Administrator Marissa & Wesley Grove. An initial application to operate an Adult Residential facility (ARF) was submitted to the Central Applications Bureau (CAB) on 5/9/2023 for a total capacity of three 3, one (1) non-ambulatory and two (2) ambulatory residents. Fire clearance was granted on 1/30/2024. LPA Delgado observed the following: Structure: Facility was a one-story house with three (3) resident bedrooms, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached three (3) car garage that is being used as an office in the front of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the office/garage to control entire house. Bedrooms: Each resident bedroom #1 and #2 will accommodate any ambulatory resident, bedroom #3 will accommodate non-ambulatory resident. Bedroom #1 will accommodate a visually/hearing impaired resident with strobe flasher. All resident (3 resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. (CONTINUED ON LIC 809C)

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GROVE HOUSE LLC	FACILITY NUMBER: 331881457
	VISIT DATE: 02/26/2024

NARRATIVE

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(CONTINUED FROM PAGE 1)

Bathrooms:
The two (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 10:11 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 106.3 degrees Fahrenheit.
Kitchen/Laundry:
An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked cabinet next to the kitchen island. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the home. Laundry detergents and cleaning supplies were observed in locked cabinets above the laundry machines away from residents.
Living/Family room:
There was a living room with enough seating for all clients and TV.
Linens and Hygiene Supplies:
An adequate supply of linens and hygiene supplies observed and was stored in a cabinet in the hallway of the residence, hygiene was stored in a locked cabinet above the laundry machines.
Yards/Outside:
Barbecue island table and sufficient chairs were observed in the backyard. There was a gate on the North side of the property with a self-locking door from the interior. All outdoor pathways were free of obstructions.
Emergency Phone Numbers, and Exit Plan:
Facility sketch were observed posted in the common areas, office and all resident bedrooms. Let-Us-No poster, Resident Rights, Visitor policy, House rules, Rights of Individuals, Designation of Facility Responsibility, LIC 500, Administrator Certificate observed.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GROVE HOUSE LLC	FACILITY NUMBER: 331881457
	VISIT DATE: 02/26/2024

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General items:
Two (2) fire extinguishers were charged and located in the kitchen and hallway. Six (6) smoke alarms and three (3) carbon monoxide detectors were tested and were observed to be in working order. Client records will be stored in a locked cabinet in the Family room. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water supply and 72-hour emergency food supply was observed. Component III was completed on February 21, 2024 at Riverside Regional Office.

Pre-Licensing is incomplete and the following corrections to be resolved by 2/28/2023:

obtain two night lights for hallways
obtain PPE supplies

An exit interview was conducted, and a copy of this report was given.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

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