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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336406665
Report Date: 08/24/2021
Date Signed: 08/24/2021 01:34:28 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:BOUNDLESS CARE FOR THE ELDERLYFACILITY NUMBER:
336406665
ADMINISTRATOR:SANDRA CHOCOBARFACILITY TYPE:
740
ADDRESS:26086 SHADY OAK COURTTELEPHONE:
(951) 315-7997
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:4CENSUS: 4DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sandra Chocobar, LicenseeTIME 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) Deborah Mullen conducted an unannounced annual inspection. LPA met with Sandra Chocobar, Licensee. LPA conducted a walk through inspection of the home. The home is a two story, seven bedroom, three bathroom home with a living room, dining room and kitchen. Residents rooms are on the first floor of the home. The home is licensed for four residents and a hospice waiver for two. The home is approved for one bedridden resident in bedroom #1.

The bedrooms were observed to have a bed, dresser, night stand and lighting for residents comfort. The bathroom was observed to be clean, safe and sanitary, with grab bars and non-slip mats for residents safety. The kitchen was observed to have the minimum three days perishable and two days non-perishable foods. Chemicals, cleansers and sharp items were locked and inaccessible to residents. The medications are locked and stored in a cabinet in the laundry room. The home was observed to be clean, safe and sanitary and to be in compliance with Title 22 regulations.

During the inspection LPA reviewed infection control practices and procedures with the Licensee. LPA observed the facility to be following current infection control guidelines.

No deficiencies were observed or cited. An exit interview was conducted and a copy of this report was reviewed with and provided to Mrs. Chocbar.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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