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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530065
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:03:26 PM

Document Has Been Signed on 02/15/2024 03:03 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:POPPY'S HOMEFACILITY NUMBER:
335530065
ADMINISTRATOR:GARDUNO, TONYAFACILITY TYPE:
735
ADDRESS:6828 LINDSEY CTTELEPHONE:
(951) 285-5587
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 4CENSUS: 0DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:LIcensee/Administrator Tonya GardunoTIME COMPLETED:
03:15 PM
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On 02/15/2024 at 01:15 PM, Licensing Program Analyst (LPA) Melody Brown arrived announced to conduct the required comprehensive annual inspection to the facility. LPA Brown met with Licensee/Administrator Tonya Garduno, introduced self and stated the purpose of the visit.

The facility has five (5) bedrooms, three (3) bathrooms, kitchen, dining room, living room, and attached garage. The facility is in the process of vendorizing by Inland Regional Center (IRC). LPA Brown completed a walkthrough of the facility. No records review, medication audit and P&I audit were completed as there are no clients at the facility.

Physical Plant: LPA Brown observed no obstructions to indoor and outdoor passageway of the facility. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Brown inspected client bedrooms; they are equipped with required furniture such as: mattresses, storage space, chairs, and sufficient lighting and nigh stands. LPA Brown inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperatures tested at 113 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide detectors, charged fire extinguishers, and first aid kit with first aid book. Posters such as; the personal rights, CCL complaint poster, emergency disaster plan were posted in a common area. Sharps and medications of clients will be kept in secure cabinets inaccessible to clients. The facility had emergency kits, emergency food and water. There are no firearms and ammunition in the facility. Overall, the facility is clean, and will operate in safe conditions for clients in care.

Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the left side of the house that leads into the backyard. The outdoor pathway on the side of the facility was free of obstruction.

*** Continuation in LIC809C ***

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: POPPY'S HOME
FACILITY NUMBER: 335530065
VISIT DATE: 02/15/2024
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Food Service: Licensee/Administrator Garduno reported that the facility will have more than two (2) day(s) supply of perishable food and more than seven (7) day(s) supply of non-perishable food and snacks once they will have clients at the facility. Dishes, cups, and utensils were stored properly.

Care & Supervision: LPA Brown observed that the facility have sufficient back -up care staff for coverage 24 hours a day, 7 days a week.



Record Review: No available records to review as no clients yet at the facility. But LPA Brown informed Licensee/Administrator Tonya Garduno regarding the client records requirements and staff records requirements. LPA Brown verified facility's Liability Insurance as current.

No deficiencies were issued during this visit. An exit interview was conducted where this report LIC809, was discussed and provided to Licensee/Administrator Tonya Garduno .

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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