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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413282
Report Date: 08/09/2021
Date Signed: 08/09/2021 12:14:01 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:TEMPLE COURT SENIOR CAREFACILITY NUMBER:
336413282
ADMINISTRATOR:ESTA HOBBSFACILITY TYPE:
740
ADDRESS:40009 TEMPLE CT.TELEPHONE:
(951) 461-4750
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
08/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Esta Hobbs, LicenseeTIME COMPLETED:
12:20 PM
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Licensing Program Analysts (LPAs) Deborah Mullen and Jesse Gardner conducted an unannounced annual inspection. LPAs met with Esta Hobbs, Licensee. LPAs conducted a walk through of the home with the Licensee. The home is licensed for a capacity of 6 non-ambulatory residents. Bedroom #1 has a fire clearance for 1 bedridden resident. The home has a hospice wavier for 3 residents.

LPAs observed the home to be a 5 bedroom, 3 bath home with a living room, dining room and kitchen. Each bedroom is furnished with bed, dresser, chair and lights for residents use. The kitchen was observed to have dishes, utensils, pots and pans and bowls for serving. LPAs observed the food supply to be in compliance with 7 days of non-perishable and 2 days of perishable foods. Sharp items are locked and stored in the kitchen cabinet and cleansers are locked and stored under the kitchen sink. The medications are locked and stored in a kitchen cabinet. LPAs also observed extra linens and towels for residents use.

During the inspection, LPAs discussed infection control practices and procedures with the Licensee.
An exit interview was conducted and a copy of this report was reviewed with and provided to Mrs. Hobbs.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021
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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