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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881582
Report Date: 09/24/2024
Date Signed: 09/24/2024 02:23:47 PM

Document Has Been Signed on 09/24/2024 02:23 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:MURRIETA GARDENSFACILITY NUMBER:
331881582
ADMINISTRATOR/
DIRECTOR:
KAVENAUGH, BRITTANYFACILITY TYPE:
740
ADDRESS:24200 MONROE AVETELEPHONE:
(951) 600-7676
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 126CENSUS: 38DATE:
09/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Brittany KavenaughTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Armando Perez, conducted an announced visit for the purpose of conducting the pre licensing inspection. LPA met with Applicant, Brittany Kavenaugh and Administrator Kylee Carter for the visit. The applicant is seeking a change in ownership with residents in care for a residential care facility for the elderly, ages 60 and up. The facility is a two-story building with a capacity for 126 residents with 20 bedridden approved on the first floor. On 07/10/24 the Murrieta Fire and Rescue approved a fire clearance. LPA toured the facility with the applicant and observed the following:

LPA inspected a sample of resident bedrooms and bathrooms. Resident bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. LPA inspected a sample of resident bathrooms; the bathroom appliances were operating in safe and sanitary conditions. Showers contained non-slip surface and access to grab bars in the showers and next to toilets. LPA measured the hot water temperature in the sampled bathrooms and measured within regulation. Bedrooms were equipped with a pull cord system to notify staff of any emergencies. LPA toured the kitchen and dining area. LPA observed two refrigerators and a freezer set at required temperatures. The facility kitchen was stocked with sufficient food to meet the required 2-day supply of perishable and 7-day supply of non-perishable food items. Access to the kitchen remains locked when not occupied with staff. Knives and sharps are stored in a designated area next to the sink. The facility had a menu posted and available for review. Dishes, glasses, and utensils were in good condition. LPA observed an activity room, a media room and a library room located on the first floor and open to residents.

The facility has a centralized storage area located in the second floor where resident files and medications are to be stored, locked, and inaccessible to the residents in care. The facility has a designated area on the first floor for staff files. LPA verified the applicants Administrator Certification, with an expiration date of February 22, 2026 and CPR certification, with the expiration date of January 19, 2026.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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: MURRIETA GARDENS
FACILITY NUMBER: 331881582
VISIT DATE: 09/24/2024
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LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, employee rights, personal rights and the Long-Term Care Ombudsman poster. The facility has an emergency disaster plan and approved infection control training plan on file. Facility contains emergency supplies and first aid kits with the required items. The facility has working telephone for client use. LPA observed several smoke detectors and carbon monoxide alarms throughout the facility. The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. No bodies of water or firearms are being kept in the facility.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA determined the facility meets the operational requirements for licensure. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to applicant Brittany Kavenaugh and Administrator Kylee Carter.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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