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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409934
Report Date: 10/04/2023
Date Signed: 10/04/2023 01:05:49 PM


Document Has Been Signed on 10/04/2023 01:05 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:HERITAGE RESIDENTIAL CARE 2FACILITY NUMBER:
336409934
ADMINISTRATOR:MARIA ARACELI UNDANFACILITY TYPE:
740
ADDRESS:24062 ORLEANS LNTELEPHONE:
(951) 698-5525
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:4CENSUS: 4DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:ADMINISTRATOR, MARIA ARACELI UNDAN.TIME COMPLETED:
01:15 PM
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On October 04, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, Maria Araceli Undan introduced herself, and stated the purpose of the visit.

LPA Mixson toured the facility, and inspected the inside and outside of the facility, and there are no obstructions to indoor and outdoor passageways currently at the time of this visit. The facility is a two story home, located at 24062 Orleans LN, Murrieta, CA. 92562. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). The facility phone number is 951-698-5525, and is operable. The LPA observed the resident bedrooms, and they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. LPA inspected resident bathrooms. The hot water temperature tested within regulations. Bathrooms were clean and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and a fire extinguisher. Posters such as; the ombudsman and CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications: were reviewed, and were locked and inaccessible to residents. The overall facility is clean, in good repair, and operating in safe conditions for residents currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient for number of residents, and there are a variety of food types available for residents. Dishes and utensils were also stored properly. Care & Supervision: Facility has sufficient staff, and staff were engaging the residents during this visit. Record Review: The LPA reviewed four resident files, and two staff files, and the required CCL reports from previous visits. There were no observable Title 22, Division 6 Regulation violations cited during todays visit.
An exit interview was conducted and a copy of this report, along with the LIC 811, was given to the Administrator, Maria Araceli Undan.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023
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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