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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881484
Report Date: 01/31/2024
Date Signed: 01/31/2024 10:06:45 AM

Document Has Been Signed on 01/31/2024 10:06 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:BOAZ HOMEFACILITY NUMBER:
331881484
ADMINISTRATOR:GARCIA, JESSEFACILITY TYPE:
735
ADDRESS:16305 AVENIDA MONTEFLORATELEPHONE:
(760) 601-7307
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 4CENSUS: 0DATE:
01/31/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:ADMINISTRATOR, JESSE GARCIATIME COMPLETED:
10:12 AM
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On January 31, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a Pre-licensing inspection and met with Administrator, Jesse Garcia, introduced herself, and stated the purpose of the visit.
The facility is located: at 16305 Avenida Monteflora, Desert Hot Springs, CA. 92240, and has four bedrooms all of which are designated for the residents. The facility has two full bathrooms and is a single story home. LPA Mixson toured the home inside and outside, along with the Administrator. The facility has a living room, dining room, kitchen, and two car garage with backyard and front yard. On 08/17/2023, The Riverside County Fire Department approved this location for four ambulatory residents only. LPA Mixson observed where the Medications: will be stored, locked, and inaccessible to residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed, tested by the fire department, and are operable. The LPA observed three fire extinguishers they charged and in the green. The LPA observed cleaning supplies locked and inaccessible to future residents. The sharp objects are locked in the laundry area, plenty of pots, pans, and other kitchen accessories. All facility doors, and passageways are clear from obstruction. There were no bodies of water on the location. The fireplace was observed and was within regulation. LPA Mixson observed beds have the required linen and supplies. There was enough extra clean linen and hygiene items. There was appropriate lighting in each room with nightstand, dresser, and chair. The facility has central heating and air conditioning systems, Internet and WFI for residents in place and are operable. The Administrator dialed the facility land line phone number (760)671-5756, and it was operable.
Outside/Yards: No obstructions observed. Component III to be completed at the Riverside Regional Office. An exit interview was conducted, a copy of this report was provided to Administrator, Jesse Garcia.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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