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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881486
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:10:41 AM

Document Has Been Signed on 04/03/2024 11:10 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:HOME OF HEARTSFACILITY NUMBER:
331881486
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		NOBLE, MICHELLEFACILITY TYPE:
735
ADDRESS:26761 HANALEI COURTTELEPHONE:
(951) 443-5227
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY: 4CENSUS: 0DATE:
04/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Applicant, Michelle NobleTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility in order to conduct a prelicensing inspection. LPA met with applicant Michelle Noble.

The facility is seeking an initial license. The facility will be licensed as a adult residential facility, with capacity of (4) ambulatory clients. The facility does not have a pool or firearms. The home is a one story home with (4) bedrooms and (2) bathrooms.

LPA conducted a walk through of the interior and exterior of the facility. The bedrooms have all the required furniture, and required hygiene supplies, and linens. LPA observed the hallway lights and the carbon monoxide detectors were in good working condition. The outdoor area was free of any hazards and had a shaded area for residents and an emergency exit. The kitchen had the ability to prepared food is a clean and safe environment. LPA observed areas were the staff and resident files would be kept as well as locked areas designated for medication, sharp objects, and cleaning supplies. The hot water temp was measures at 111.8F. The facility has a land line at (951)443-5227.

There are no objections for the applicant to proceed in the prelicensing process. An exit interview was conducted with the applicants, and copy of this report was reviewed and provided to them.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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