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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881553
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:19:38 PM

Document Has Been Signed on 06/12/2024 01:19 PM - 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:NEW HOPE FACILITY HOME LLCFACILITY NUMBER:
331881553
ADMINISTRATOR/
DIRECTOR:		GIRON, ELIZABETHFACILITY TYPE:
735
ADDRESS:14446 CHANTRY DRIVETELEPHONE:
(951) 660-5585
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 4CENSUS: 3DATE:
06/12/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Applicant, Elizabeth GironTIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On 6/12/2024, Licensing Program Analyst (LPA), Janette Romero made an announced visit to conduct a pre-licensing evaluation and met with Applicant, Elizabeth Giron. A change of ownership application to operate a Adult Residential Facility (ARF) was received by the Central Applications Bureau (CAB) on 1/15/2024. Fire Clearance was granted on 3/27/2024 for total capacity of four (4) ambulatory clients.

LPA toured the facility with Applicant Giron. During the tour, LPA observed the facility is made up of a one (1) story home with two (2) client bedrooms, two (2) bathrooms, a kitchen, dining room, living room, staff room, and attached garage. The facility has a central heating and air conditioning system installed with a central panel located in the living room to control entire house. Applicant Giron tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. Client bedrooms are each furnished with a bed, chair, and night stand. Both bathrooms have a working toilet, wash basin and have paper towels, toilet paper, and soap readily available. LPA toured the kitchen and observed a the knives to be secured in a locked kitchen drawer and cleaning solutions and disinfectants secured in a locked kitchen cabinet under the sink. LPA observed the stove to be operational. Refrigerator/freezer are in working condition and the facility had a 2-day supply of perishable foods and 7-day supply of non-perishable foods. The facility also has adequate seating for meals for all clients. Medications are secured in a file cabinet stored near the dining room. LPA observed additional clean linens and towels stored in hallway cabinets. Emergency water supply is stored in the laundry room. A wood wall secured the entire backyard. There is a swinging self-latching gate on the left and right side of the property. Indoor and outdoor pathways were free of obstructions. There was no bodies of water observed on the premises. Let-Us-No poster, emergency phone numbers and exit route/maps are visibly posted in the living room.

During today's visit, LPA did not observe any issues or concerns. The facility's pre-licensing inspection is now complete and there are no corrections required. Applicant is scheduled to attend COMP III on 6/14/2024 at the Riverside Regional Office. Final approval of licensure is determined by CAB.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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