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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409595
Report Date: 10/16/2020
Date Signed: 10/16/2020 12:05:19 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:SCENIC VIEW HOME CAREFACILITY NUMBER:
336409595
ADMINISTRATOR:MARILYN HOLMESFACILITY TYPE:
740
ADDRESS:7349 LIPPIZAN DRTELEPHONE:
(951) 727-0175
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 4DATE:
10/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Earl HolmesTIME COMPLETED:
10:47 AM
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Licensing Program Analyst (LPA) Jennifer Semin conducted a virtual case management visit via Zoom due to COVID-19 restrictions to check on the Health & Safety and Welfare of residents in care. LPA spoke with licensee Earl Holmes.

A virtual tour of the facility was conducted. LPA observed 3 caregivers present. Facility has a capacity of 6 residents with a current census of 4. Residents were observed cheerful, well-groomed and enjoying lunch. Linens and hygiene items are sufficient. Each room is properly equipped with lamps and appropriate lighting to ensure residents comfort and safety. Common area used by residents are clean and unobstructed. Facility has ample and properly stored food supply. Non-perishable and perishable food is sufficient for number of residents in care. Toxic items are inaccessible to residents in care. Medication is centrally stored and locked.
Based on the observations made during today’s virtual visit LPA did not observe any deficiencies.

An exit interview was conducted with licensee Earl Holmes via telephone and a copy of this report was provided via email. Report with facility representative signature was obtained.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2020
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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