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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881675
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:23:32 PM

Document Has Been Signed on 01/28/2025 03:23 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:TIMOTHY HOMEFACILITY NUMBER:
331881675
ADMINISTRATOR/
DIRECTOR:		SMITH, DAVIDFACILITY TYPE:
737
ADDRESS:41218 CREST DRIVETELEPHONE:
(951) 267-3556
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 4CENSUS: 4DATE:
01/28/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Assistant Administrator, Cristhian RodriguezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannouned visit to the facility in order to conduct a Case Management Visit. LPA met with Okoia Nixon, the AM Shift Lead who was informed of the purpose of the visit. During the visit, the PM shift started and LPA continued to the visit with Assistant Administrator. At the time of the visit there were (10) staff including the shift lead

LPA conducted a tour of the facility with the AM Shift Lead, and observed the interior and exterior of the facility. LPA reviewed the staff schedule for the facility. LPA observed the utilities were on and operating. LPA observed the facility had electricity and running water. LPA observed the food supply met the perishable and non-perishable food requirements. During the time of the visit, LPA conducted a visual check of the facility residents which were observed in their rooms and common areas of the facility. LPA conducted interviews with the staff.

No immediate health or safety issues were observed during the time of the visit. An exit interview was conducted and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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