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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881565
Report Date: 10/22/2024
Date Signed: 10/22/2024 03:18:05 PM

Document Has Been Signed on 10/22/2024 03:18 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:
331881565
ADMINISTRATOR/
DIRECTOR:		GIRON, ELIZABETHFACILITY TYPE:
735
ADDRESS:24481 BRODIAEA AVETELEPHONE:
(951) 660-5585
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 0DATE:
10/22/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:42 PM
MET WITH: Elizabeth GironTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA),Abdoulaye Zerbo conducted an announced pre-licensing inspection at the facility and met with Applicant, Elizabeth Giron

Application: The inspection is for an initial Adult Residential Facility (ARF) application. The Riverside County Fire Department approved a fire clearance for Two (2) non-ambulatory and four(4) ambulatory clients on 05-9-2024.

Buildings and Grounds: The home is a single story building composed of four (4) client bedrooms, a living room area, two (2) bathrooms, a laundry room, kitchen and dining area, a garage, and front and back yard. The interior and exterior walkways of the home were observed to be clutter free with no obstructions. Smoke and Carbon Monoxide detectors are hard wired in working order. There is no gated pool and no weapons stored in the home. Client bedrooms are fully furnished, and privacy is available. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer were available and in working order.

Storage and Supplies: Medications will be stored in a locked cabinet next to the living room, inaccessible to any unauthorized individuals. Secured locked cabinets in the living room are available for facility files, staff files and client files. A complete first aid kit was observed to be available. Cleaning supplies will be stored away in a secured location under the kitchen sink. Linens, and equipment appeared to be in good repair and sufficient for the approved census. Fire extinguishers were available and fully charged with an expiration date of 07-16-2025.

Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and freezer are in working order. Sharps knives will be stored in a locked cabinet in the kitchen area, available only to authorized individuals.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NEW HOPE FACILITY HOME LLC
FACILITY NUMBER: 331881565
VISIT DATE: 10/22/2024
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Forms: The following signs were observed to be posted at the home: Personal Rights, Complaint information, Emergency disaster plan, the facility sketch, ombudsman's poster. LPA verified the Administrator's Certification, with an expiration date of August 21, 2025 and CPR certification with the expiration date of May 22, 2026

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. The applicant has completed COMP III orientation on 06-14-2024. LPA determined the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and a copy of this report was discussed and provided to administrator Ma Luisa Reyes.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC809 (FAS) - (06/04)
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