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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336406709
Report Date: 08/22/2024
Date Signed: 08/22/2024 04:05:54 PM


Document Has Been Signed on 08/22/2024 04:05 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:ANGELVIEW CARE HOMES INC. @ RANCHO BAJAFACILITY NUMBER:
336406709
ADMINISTRATOR:F.AUMENTADO/M.BOCOFACILITY TYPE:
735
ADDRESS:27802 RANCHO BAJATELEPHONE:
(951) 485-7079
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY:6CENSUS: 6DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Staff Angel BastonaTIME COMPLETED:
01:10 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
On 8/22/24 Licensing Program Analyst's (LPAs) Valerie Flores and Abdoulaye Zerbo conducted an unannounced one (1) year required visit. LPA's were granted entry by caregiver, Angel Bastona, who was informed of the purpose of visit. At the time of the visit there were three (3) staff, Administrator and six (6) 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, HarlanKane Flynn. The physical plant is a single-story structure that contained four (4) resident bedrooms, one (1) staff bedroom, and two (2) bathrooms. The facility has a dining room, kitchen, family room. 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 105.5-degree Fahrenheit meeting within the required limits. LPA's observed a refrigerator with non-perishable foods in the garage along with emergency food and water. Dishes and utensils were in sufficient supply and in good repair. Disinfectant, knives, and other sharp items were located in a locked cabinet underneath the kitchen sink. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. LPA's observed charged fire extinguishers mounted in the kitchen.



Staff files reviewed included but not limited to criminal record clearance, required annual training's and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, appraisals, and an outline for care of resident restrictive health condition by a physician. Facility sketch, personal rights, see something say something and emergency disaster plan is posted throughout the facility. According to staff, there are no firearms or ammunition on the premises.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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 2


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: ANGELVIEW CARE HOMES INC. @ RANCHO BAJA
FACILITY NUMBER: 336406709
VISIT DATE: 08/22/2024
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
26
27
28
29
30
31
32
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, Mae Embalsado.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2