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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336402166
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:14:46 PM


Document Has Been Signed on 03/22/2022 01:14 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
RIVERSIDE, CA 92507



FACILITY NAME:JMP CARE HOMEFACILITY NUMBER:
336402166
ADMINISTRATOR:EMELITA M. PRICEFACILITY TYPE:
740
ADDRESS:2771 CAMBRIDGE AVENUETELEPHONE:
(951) 766-5370
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:6CENSUS: 2DATE:
03/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:58 AM
MET WITH:Licensee, Emelita M. Price TIME COMPLETED:
01:20 PM
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On 3/22/22 Licensing Program Analyst (LPA)’s David Cuevas and Chinwe Nwogene visited facility to do an annual inspection, while doing walk through of facility with Licensee, Emelita M. Price LPA ‘s identified passageway in garage leading to an emergency exit to be obstructed by a door placed sideways. Per Licensee, this is intended to keep pet dog from running away. Deficiency will be cited and civil penalties assessed. Additionally, during walk through LPA’s identified a bedroom to have been built within the garage, per Licensee bedroom was built about 7 months ago. LPA’s identified a staff to be residing in that bedroom. Staff is live scanned and associated to the facility. LPA’s advice Licensee that a follow up case management visit will be needed to ensure that bedroom in garage was included in the original submitted floor plan.

Based on observations deficiency will be cited on LIC 809 D.

An exit interview was done with Licensee, Emelita M. Price in which this report, LIC 809D, Civil Penalties, and appeal rights were provided.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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


Document Has Been Signed on 03/22/2022 01:14 PM - It Cannot Be Edited

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
RIVERSIDE, CA 92507


FACILITY NAME: JMP CARE HOME
FACILITY NUMBER: 336402166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/22/2022
Section Cited

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All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.This requirement was not met evidence by.
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While touring facility LPA identified an obstructed passageway leading into an emergency exit doorway within the garage. Per facility staff this is done to prevent pet dog from going to other areas of the home. This possess an immediate risk to the health, safety, and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
LIC809 (FAS) - (06/04)
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