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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412432
Report Date: 03/07/2024
Date Signed: 03/07/2024 11:14:11 AM


Document Has Been Signed on 03/07/2024 11:14 AM - 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:FRIENDS HOME CARE AT MORGAN VALLEYFACILITY NUMBER:
336412432
ADMINISTRATOR:RICHARD & JENNIFER FRIENDSFACILITY TYPE:
740
ADDRESS:45165 RIDEAU STREETTELEPHONE:
(951) 383-8038
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:6CENSUS: 6DATE:
03/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee, Richard FriendTIME COMPLETED:
11:30 AM
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On 3/7/2024, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct an annual required inspection. LPA met with Licensee, Richard Friend who was informed of the purpose of the visit. During the visit, there was five (5) residents and two (2) staff present. LPA observed residents resting in their rooms
and watching television. Staff present have a criminal record clearance on file and a valid first aid certification.

The facility is made up of a one-story home with five (5) resident bedrooms, two (2) full bathrooms, a kitchen, dining room, living room and attached garage. The facility has a fire clearance to care for six (6) non-ambulatory residents over the age of 60, an approved hospice waiver for four (4) residents and a dementia care plan of operation. LPA conducted a tour of the facility's interior and exterior with Licensee. During the tour, LPA observed food is stored a safe and healthful manner and the facility has more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Licensee tested the carbon monoxide/smoke detectors and LPA found them to be operational. LPA observed fire extinguishers charged and mounted throughout the facility, which were serviced on 3/18/2023. Indoor and outdoor passageways are free of obstructions and the physical plant is in good repair. Disinfectants, cleaning supplies, medications and sharp instruments are kept locked and inaccessible to residents. Resident bedrooms had the required bedding, furniture and lighting. The facility has additional linen and towels available for the residents in care. The hot water temperature in the resident bathrooms measured at 110- and 112-degrees Fahrenheit. During today's visit, LPA did not issue any deficiencies. An exit interview was conducted where a copy of this report was reviewed and provided to Licensee.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2024
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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