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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413087
Report Date: 06/08/2021
Date Signed: 06/08/2021 04:35:10 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:BROOKDALE MURRIETAFACILITY NUMBER:
336413087
ADMINISTRATOR:QUEEN AYERSFACILITY TYPE:
740
ADDRESS:24350 JACKSON AVETELEPHONE:
(951) 696-5753
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:82CENSUS: 77DATE:
06/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Queen Ayers, Executive DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst Deborah Mullen conducted an unannounced annual inspection. LPA met with Queen Ayers, Executive Director and Jennifer Larson, Health and Wellness Director. The facility is licensed for 82 non-ambulatory residents, of which 10 may be bedridden. The facility has a hospice waiver for nine residents.

The facility is a two story building with 74 apartments. LPA conducted a walk through inspection of the facility. The facility has a large dining room, kitchen, activities room and several other areas throughout the building for residents to sit and relax. The outside of the building is fenced and has areas with tables, and chairs in the shade for residents use.

During the inspection LPA reviewed infection control practices and protocols with Ms. Ayers. The facility is following current infection control practices for the safety of residents and staff.

No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was reviewed with and provided to Ms. Ayers.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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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