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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336406711
Report Date: 01/06/2025
Date Signed: 01/06/2025 01:58:56 PM

Document Has Been Signed on 01/06/2025 01:58 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:COVEY QUAIL HOMEFACILITY NUMBER:
336406711
ADMINISTRATOR/
DIRECTOR:		CORNELIA TODORFACILITY TYPE:
735
ADDRESS:13864 COVEY QUAIL LANETELEPHONE:
(951) 924-0300
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 5CENSUS: 4DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Licensee and Administrator, Cornelia TodorTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced Annual Required Visit. LPA was granted entry by and met with Licensees Danny and Cornelia Todor, who were informed of the purpose of the visit. During the time of the visit there were (1) client and (2) staff.

The facility is a (1) story home with (6) bedrooms and (3) bathrooms, with (3) bedrooms for the clients. There are no bodies of water, weapons or fire arms kept at the facility. LPA conducted interviews, records review and a walk through.

LPA observed the kitchen had equipment in good working condition. The facility meets the (2) day perishable and (7) day non-perishable supply of food. The knifes and cleaning supplies were kept locked. The outdoor area was observed to be free of hazards and has an emergency exit. LPA observed the resident bedrooms had the required furniture and the bathrooms have grab bars and hygiene supplies for residents. The hot water temperature was recorded at 111.7F and the carbon monoxide and smoke alarms are in working condition. There are cleaning supplies to do regular cleaning of the facility. Emergency and PPE supplies were available.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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: COVEY QUAIL HOME
FACILITY NUMBER: 336406711
VISIT DATE: 01/06/2025
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LPA reviewed (4) client records which possessed all required paper work. LPA reviewed (2) staff records which possessed all required records and training. The current administrator meets the Administrator requirements and has a current Administrator's Certificate. The staff schedule showed staff coverage at all times.

The resident medication was kept locked. LPA reviewed resident medications which were accounted for on the centrally stored medication lists.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
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