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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881596
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:28:37 PM


Document Has Been Signed on 09/16/2024 02:28 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:DIAMOND RCFE OF MURRIETAFACILITY NUMBER:
331881596
ADMINISTRATOR:CARTER, KIMBERLYFACILITY TYPE:
740
ADDRESS:26973 HOLLY GROVE CT,TELEPHONE:
(951) 304-2162
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
09/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Applicant, Kimberly CarterTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Janira Arreola and Armando Perez, conducted an announced visit for the purpose of conducting the prelicensing inspection. LPA met with Applicant, Kimberly Carter for the visit. The applicant is seeking a change in ownership with residents in care for a residential care facility for the elderly with a capacity for (6) residents, ages 60 and up. LPAs toured the facility and observed the following:

The home is a one story home with (5) bedrooms and (2) bathrooms and attached garage. The fire clearance conducted on 08/12/2024 by Murrieta Fire and Rescue was approved the home for (6) bedridden residents. The resident bedrooms were observed to had the appropriate linens, furniture such as bed, dresser, closet space, light, night stand and chair. The home has extra linens, First aid kit was locked in locked medication closet where resident medications will be stored. PPE equipment was observed around the facility, in residents rooms and in garage. The facility had a storage of incontinent supplies and hygiene items for residents. The facility kitchen has enough pots and pans, cooking utensils, plates and cups for (6) Residents. The kitchen had the appropriate food items. Kitchen knifes will be kept locked with the in the kitchen. Emergency supplies are kept in the facility garage, and night lights are kept around the facility hallways. The laundry room was observed be functional, and the facility possesses cleaning supplies to conduct regular cleaning of the facility. The dining room has enough seating for (6) residents, and the outdoor space has enough seating for (6) residents LPA observed the home has activities for clients to engage in. The smoke alarms and carbon monoxide detectors were operational and hot water temperature was read at 109.4F. The land line was observed to be operational (951-304-2162). Required postings were found on the facility walls, and the facility has current records for staff and residents. No bodies of water or firearms are being kept in the facility.

There are no objections for the applicant to proceed in the prelicensing process. An exit interview was conducted were this report was reviewed and provided to the applicant.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
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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