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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413087
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:47:11 AM


Document Has Been Signed on 06/22/2023 11:47 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 AC/SC, 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: 62DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Cindy Garcia, Executive DirectorTIME COMPLETED:
12:00 PM
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On Thursday, 6/22/2023, Licensing Program Analyst Janette Romero conducted an unannounced annual required visit to the facility at 9:15 a.m. LPA met with Executive Director Cindy Garcia who was informed of the purpose of the visit. The facility is licensed for 82 non-ambulatory residents, of which 10 may be bedridden. The facility has a hospice waiver for nine (9) residents and there are currently eight (8) residents on hospice residing at the facility.

The facility is made up of a two-story building with 74 apartments. LPA toured the interior and exterior, reviewed facility documents and conducted resident and staff interviews. The facility has a large dining room, kitchen, activities room and several other common areas throughout the building available for the residents. The outside of the building is fenced and has several tables with shaded areas available for the residents.

LPA issued a Technical Advisory and noted a Personal Rights/Reporting Requirements training is required for staff as a refresher training. Facility conducted the last Personal Rights training on 4/20/2023, for all staff and the sign in sheet for staff training listed the subjects covered as, “Reporting Events, Changes of Condition, and Resident Rights.”

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 Executive Director Garcia.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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