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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403045
Report Date: 09/15/2022
Date Signed: 09/15/2022 12:07:13 PM


Document Has Been Signed on 09/15/2022 12:07 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:MAJESTY VILLAGEFACILITY NUMBER:
336403045
ADMINISTRATOR:ALMA TUSCANOFACILITY TYPE:
735
ADDRESS:8595 PHILBIN AVENUETELEPHONE:
(951) 509-6826
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:80CENSUS: 76DATE:
09/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:ADMINISTRATOR, ALMA TUSCANOTIME COMPLETED:
12:10 PM
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On September 15, 2022, Licensing Program Analyst (LPA), Venus Mixson made an unannounced case management health and safety visit to the above facility. LPA Mixson met with Administrator, Alma Tuscano and explained the purpose of the visit.

LPA Mixson interviewed Administrator, and requested pertinent documentation. LPA received documentation.

LPA Mixson toured the facility. At the time of the visit there were 76 residents and 7 caregivers. There are no imminent health and/or safety concerns observed at the time of visit. LPA observed all facility utilities to be on and operating without issue. There was a sufficient amount of staff present at the facility to provide care. LPA assessed the available food supply and observed that the supply exceeds the requirement of a two (2) day supply of perishable foods and a seven (7) day supply of non-perishable foods. Medications were found to be in sufficient supply as well.

Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to Administrator.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2022
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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