336411100-5-24-2023-18-AS-CNWE-CS5TUN-20230524150238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336411100
Report Date: 05/24/2023
Date Signed: 05/24/2023 03:02:45 PM

Document Has Been Signed on 05/24/2023 03:02 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:	WARWICK RESIDENTIAL CARE		FACILITY NUMBER:	336411100
ADMINISTRATOR:	SUZETTE MANALANSAN		FACILITY TYPE:	735
ADDRESS:	2010 WARWICK ST.		TELEPHONE:	(951) 654-0416
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92582
CAPACITY: 6		CENSUS: 0	DATE:	05/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Suzette Manalansan, Licensee		TIME COMPLETED:	03:10 PM

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On 5/24/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Licensee, Suzette Manalansan who was informed of the purpose of visit. At the time of visit there was 0 staff and 0 residents present. LPA toured the facility inside and out with Suzette.

Tour included:

Kitchen; LPA toured the kitchen and observed the kitchen to be clean. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lids. Dishwasher is used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 2 degrees Fahrenheit and Freezer was measures at 0 degrees Fahrenheit.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 71 degrees Fahrenheit.

Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medications; LPA did not observe any mediation because there is no clients in care, however, medications will be stored in a locked medication cabinet by the hallway. The first aid kit was complete.

Continue on LIC809-C.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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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: WARWICK RESIDENTIAL CARE	FACILITY NUMBER: 336411100
	VISIT DATE: 05/24/2023

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Continued from LIC809.

Bathroom; LPA toured hall bathroom and observed bathroom to be clean and equipped with textured floor. There is also a good number of personal toiletries available. The hot water measured at 120 degrees Fahrenheit.

Bedroom; LPA toured four #4 out of #4 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Resident #1 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 120 degrees Fahrenheit.

Garage; LPA tour the garage and observed garage to be clean.

Laundry; LPA observed laundry room to be clean. Washing machine and dryer are all in good repair and sufficient for approved census. Cleaning supplies are stored away in the laundry room, inaccessible to clients.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable foods and all food was properly stored. LPA did not observe two days of perishable food supply. Licensee stated perishable food will be made available when residents are admitted to the facility.

Records: No staff or resident record was reviewed because facility currently has no staff and residents. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 10/06/2024.

Interview; No interview was conducted.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Rizza Javier.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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