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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336402521
Report Date: 10/04/2023
Date Signed: 10/04/2023 04:38:06 PM


Document Has Been Signed on 10/04/2023 04:38 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: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: 5DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:58 PM
MET WITH:LEAD CAREGIVER, CAROLINA CASTRO TIME COMPLETED:
04:48 PM
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On October 04, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson spoke with the Lead Caregiver, Carolina Castro introduced herself, and stated the purpose of the visit.

LPA Mixson toured the facility, and inspected the inside and outside of the facility, and there were no obstructions to indoor and outdoor passageways currently at the time of this visit. The facility is a single story home, located at 23276 Spring Meadow Dr, Murrieta, CA. 92562. Physical Plant: The facility phone number is 951-600-2894, and is operable. The LPA observed the resident bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected the facility bathrooms, and the hot water temperature tested within regulations. Bathrooms were clean and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as; the ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies, sharps, and other dangerous items were kept locked and inaccessible to the residents. There was a designated storage space for resident/staff files. Medications: were reviewed, and were locked and inaccessible to residents. The overall facility is clean, the furniture is in good repair. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision: Facility has sufficient staff, and staff were engaging the residents during this visit. Record Review: The LPA reviewed five resident files, one staff file, and the required CCL reports from previous visits. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit.
An exit interview was conducted and a copy of this report, along with the LIC 811, was given to the Lead Caregiver.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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