<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336402521
Report Date: 10/07/2021
Date Signed: 10/07/2021 01:38:22 PM

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:SPRING MEADOW HOME CAREFACILITY NUMBER:
336402521
ADMINISTRATOR:MEJARES, ABIGAILFACILITY TYPE:
740
ADDRESS:23276 SPRING MEADOW DR.TELEPHONE:
(951) 600-2894
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 6DATE:
10/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Caregiver Carolina CastroTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Caregiver Carolina Castro and explained the purpose of the visit. At the time of visit there were 2 staff and 6 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer). Staff were also observed wearing appropriate face coverings (surgical masks).

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks two times a day. However, the temps are being documented. LPA encouraged for the temperatures to be recorded as the logs can be used as an indication of a change in condition. Administrator stated that the facility will begin recording resident temperatures effective this evening. Administrator stated that the log will include the resident's name, date, and two slots; one for the AM and one for the PM temperature readings. The facility will contact the resident's physician should there be event of any COVID-19 related illnesses. Per facility staff the highly touched surfaces are cleaned and disinfected two times daily (once in the morning and in the evening before bed).

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to Caregiver Carolina Castro.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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 1