<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881512
Report Date: 10/30/2023
Date Signed: 10/30/2023 11:44:41 AM

Document Has Been Signed on 10/30/2023 11:44 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:DION HOME LLCFACILITY NUMBER:
331881512
ADMINISTRATOR:OWENS, OMORODIONFACILITY TYPE:
735
ADDRESS:29026 QUAIL BLUFF ROADTELEPHONE:
(714) 392-1860
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 4CENSUS: 0DATE:
10/30/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:ADMINISTRATOR, OMORODION OWENSTIME COMPLETED:
11:58 PM
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
On October 30, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a pre-licensing- Change of location (CHOL). LPA Mixson met with Administrator, Owens and introduced herself.
The location is a single-story home with located at 29026 Quail Bluff Road, Menifee, CA. 92584 and has five bedrooms, a living room, dining room, and a kitchen, with a two car garage, and backyard and front yard. The Riverside County Fire Department approved this facility for four (4) Ambulatory residents, on 10/20/2023. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and their Administrator’s certificate is current up to August 2024.
LPA Mixson observed where medications will be stored, locked, and inaccessible to the 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 and are operable. LPA Mixson observed the fire extinguisher, it was charged and in the green, and last charged on March 06, 2023. The cleaning supplies were locked and inaccessible, along with the sharp objects. The knives were locked in a kitchen drawer, plenty of pots, pans, and other kitchen accessories. The facility has some non-perishable food items, hygiene supplies for residents. All doors, and passageways are clear of obstruction. There were no bodies of water on the premises, and the fireplace was covered with screen, and zipped locked. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA Mixson observed central heating and air conditioning systems, and they are operable. The Administrator dialed the land line phone number (951) 390-1033, and it was operable. Outside/Yards: Had shade and covering for shaded visit, and activities, and there were no obstructions observed. The Administrator stated there were no firearms, and/or ammunition on the premises.
LPA requested and documented dates available for Component III to be completed in the Riverside Office once scheduled.
An exit interview was conducted, a copy of this report was provided to Administrator, Owens.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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 1