336403457-8-30-2024-18-AS-VFLS-D8MKVC-20240830081406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336403457
Report Date: 08/29/2024
Date Signed: 08/30/2024 08:15:13 AM

Document Has Been Signed on 08/30/2024 08:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BRILLO ADULT RESIDENTIAL CARE #2		FACILITY NUMBER:	336403457
ADMINISTRATOR:	INGRID E. BRILLO		FACILITY TYPE:	735
ADDRESS:	13830 MANGOWOOD DR.		TELEPHONE:	9512439727
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY:	4	CENSUS: 2	DATE:	08/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Administrator Christopher Alcayde		TIME COMPLETED:	03:05 PM

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On 8/29/24 Licensing Program Analyst's (LPAs) Valerie Flores, Abdoulaye Zerbo, and Andrei Castillo conducted an unannounced one (1) year required visit. LPA's were granted entry by caregiver, Remedios Pascua, who was informed of the purpose of visit. At the time of the visit there were one (1) staff, Administrator and two (2) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA's observed the following during today's visit:

LPA's conducted a tour of the facility with staff member, Remedios Pascua. The Facility was operating within their scope outlined in their license. The physical plant contained three (3) resident bedrooms, two (2) staff bedroom, and two (2) bathrooms. The facility has a dining room, kitchen, two (2) living room, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Water temperature measured at 110.8-degree Fahrenheit meeting within the required limits. LPA's observed a refrigerator with non-perishable foods on the outside patio. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items are located in the kitchen in a locked cabinet. Resident bedrooms had the required bedding, furniture, and lighting. Disinfectants and cleaning solutions were secured in a locked cabinet under the kitchen sink. Centrally stored medication and all facility files are located in a locked closet near the entrance. The smoke and carbon monoxide detectors were tested and were observed to be operable. LPA's observed a charged fire extinguisher mounted in the kitchen.

Continuation on LIC809C...

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie Flores	TELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRILLO ADULT RESIDENTIAL CARE #2	FACILITY NUMBER: 336403457
	VISIT DATE: 08/29/2024

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Staff files reviewed included but not limited to a criminal record clearance, required training, personnel records and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, physician reports, and current IPP. Facility sketch, see something say something, personal rights, and emergency disaster plan is posted on a wall near the entrance. According to Administrator Christopher Alcayde, there are no firearms or ammunition on the premises.

During today's visit, LPA's did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator, Christopher Alcayde.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie Flores	TELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

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