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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413282
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:25:17 PM

Document Has Been Signed on 09/27/2022 03:25 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
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: 0DATE:
09/27/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Esta Hobbs - LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Crystal Colvin conducted an unannounced visit to the facility for the purpose of a health and safety check. LPA Colvin met with facility Licensee Esta Hobbs, who was informed of the purpose of the visit.

Upon arrival to the facility, LPA Colvin observed a paper notice on the front door stating that the facility is temporarily closed. LPA Colvin was granted access to the facility, conducted a tour of the interior of the facility, and confirmed that there are no residents present. According to the Licensee, there were previously only two residents at the facility, one of which moved to another facility of the Licensee's, and the other which relocated elsewhere. No immediate health and safety concerns observed during today's inspection.

An exit interview was conducted where this report was reviewed and provided to Licensee Esta Hobbs.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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