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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412349
Report Date: 06/06/2022
Date Signed: 06/06/2022 04:17:37 PM

Document Has Been Signed on 06/06/2022 04:17 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:DAVID & TERRIE'S HOMEFACILITY NUMBER:
336412349
ADMINISTRATOR:PURCELL, TERRIEFACILITY TYPE:
735
ADDRESS:8012 CITRICADO LNTELEPHONE:
(714) 719-8278
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 6CENSUS: 6DATE:
06/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:David Ferguson & Terrie Purcell - LicenseesTIME COMPLETED:
04:30 PM
NARRATIVE
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On this date, Licensing Program Analyst (LPA) Crystal Colvin made an unannounced visit to the facility to investigate a complaint #18-AS-20220603093754. During today's inspection, LPA Colvin observed the following deficiency, which was reviewed with Licensees David Ferguson & Terrie Purcell:

LPA Colvin inquired with Licensees about how staff dry laundry, and if laundry is ever dried outside. Licensee David Ferguson confirmed that sometimes bedding is dried outside, as it will break the dryer. Licensee David stated it is hung on a fence to dry, not a clothes line. LPA Colvin showed Licensees a photo which was submitted to Community Care Licensing (CCL) which shows clothing and bedding laying out on the grass in the backyard of the facility (note CCL was also submitted a photo of towels being dried on the fence in the backyard). This is not a sanitary means to dry residents' clothing or linen, as these areas are not regularly sanitized or cleaned. Deficiency cited.

An exit interview was conducted with Licensees David Ferguson & Terrie Purcell, and a copy of this report, LIC 809D, and appeal rights was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2022
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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Document Has Been Signed on 06/06/2022 04:17 PM - It Cannot Be Edited


Created By: Crystal Colvin On 06/06/2022 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAVID & TERRIE'S HOME
FACILITY NUMBER: 336412349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2022
Section Cited
CCR
80087(a)

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Buildings and Grounds: (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by:
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Licensee agrees to have a meeting with all staff regarding personal rights of residents and healthful ways to launder and dry items. LPA Colvin additionally reccomends a clothing line (or indoor dring rack) if the Licensee wishes to continue refrain from drying blankets in the dryer. Licensee to confirm correction by
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Based on interviews and photographic evidence, the Licensees did not comply with the above regulation with at least one area/aspect of the facility (laundry). Staff have used the backyard fence and grass to dry residents' clothing and linen. This is a potential personal rights violation.
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Plan of Correction date of 6/10/22.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Crystal Colvin
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022


LIC809 (FAS) - (06/04)
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