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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881737
Report Date: 01/06/2026
Date Signed: 01/06/2026 10:32:40 AM

Document Has Been Signed on 01/06/2026 10:32 AM - 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:VINEYARD PLACEFACILITY NUMBER:
331881737
ADMINISTRATOR/
DIRECTOR:		TAYLOR, THOMASFACILITY TYPE:
740
ADDRESS:24325 WASHINGTON AVETELEPHONE:
(951) 387-8410
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY: 82CENSUS: 0DATE:
01/06/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Executive Director Thomas TaylorTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 1/6/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an announced visit to the facility for the purpose of conducting the prelicensing inspection. LPA met with Executive Director Thomas Taylor and conducted a tour of the facility. LPA observed the following during today’s visit:

The facility is a single-story structure which consists of (64) sixty-four resident units to which some are share units. The fire safety inspection conducted on 4/3/2025 granted a capacity of (2) two ambulatory, (60) sixty non-ambulatory, and (20) twenty bedridden residents. Resident units were observed to have the required bedding, furniture, seating, and functional lighting. No units will maintain no more than (2) two residents. Resident showers were equipped with the required slip resistant material and grab bars. Toilet area was equipped with the required grab bars. Water temperature measures within Title 22 standards. Indoor/outdoor passageways were free of obstruction. During the tour, LPA observed a supply closet equipped with a sufficient number of games, crafts, and other activities. Medication will be centrally stored in a locked room located near the dining room. Facility will provide laundry services to every resident unless resident elects not to enroll in laundry service. LPA did not observe any bodies of water. Kitchen was kept clean and free of litter. LPA observed a (2) two-day supply of perishable foods and (7) seven-day supply of non-perishable foods. LPA reviewed the Emergency Disaster Plan and confirmed that the applicants have addressed all requirements in Title 22 Section 87212. Per Executive Director, the facility does not maintain any firearms and/or ammunition on the premises.

(Continue to LIC809)

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: VINEYARD PLACE
FACILITY NUMBER: 331881737
VISIT DATE: 01/06/2026
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(Continuation from LIC809)

Postings of PUB475, LTCO, and resident personal rights were observed on the walls near the dining room area. Staff files will be maintained in Staff Development Directors office which is made inaccessible to unauthorized personnel. Resident files were located in a secure filing cabinet located in the Executive Directors office making it readily accessible to authorized staff and the licensing department. During the visit, LPA did not observe any health and safety concerns.

LPA has determined the facility meets the operational requirements for licensure. Final approval of licensure will be determined by the Centralized Application Bureau (CAB). The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. Facility is scheduled to attend COMP III on 1/13/2026.

An exit interview was conducted, and a copy of this report was discussed and provided to Executive Director Thomas Taylor.

NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Valerie Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
LIC809 (FAS) - (06/04)
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