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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413282
Report Date: 06/22/2023
Date Signed: 06/22/2023 01:15:37 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/22/2023 01:15 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
RIVERSIDE AC/SC, 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: 0DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee Esta HobbsTIME COMPLETED:
01:30 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 12:30 p.m. LPA was greeted and granted entry by Staff Griselda Torres-Garcia. The facility is licensed for six (6) non-ambulatory residents. The facility has a hospice waiver for three (3) residents and fire clearance has been granted for one (1) bedridden resident approved for Bedroom #1. Licensee Esta Hobbs arrived during the visit. There are currently no clients in care.

The facility is made up of a one-story home with five (5) bedrooms and three (3) bathrooms. LPA toured the facility’s interior and exterior. The facility has two (2) dining rooms and kitchen/family areas, and an attached garage. Fencing secured the patio area. All indoor and outdoor passageways were free from obstructions. Resident bedrooms were each furnished with a bed, night stand and sufficient closet storage space. LPA observed secured storage areas for medications, cleaning solutions and knives/sharp instruments available for future residents.

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 Licensee Hobbs.
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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