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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413282
Report Date: 02/02/2024
Date Signed: 02/02/2024 10:37:46 AM


Document Has Been Signed on 02/02/2024 10:37 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 ASC, 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:
02/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Licensee, Esta HobbsTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct a Plan of Correction (POC) visit. LPA met with Licensee, Esta Hobbs, who was informed of the purpose of the visit. At the time of the visit LPA conducted a walk through and reviewed staff clearances.

The following POC's were corrected at the time of the visit:
On office visit conducted with the licensee, Health and Safety Code (HSC) Section 1569.191(b) Sale of licensed facility was cited and POC was to send LPA proof of submission of application for change of ownership. This was due by 1/24/2024. LPA received proof of receipt from the new applicant via email for application sent 1/25/2024. During the time of the visit the tracking number was reviewed from the receipt provided and it was confirmed that the information had been received to mailing address of Centralized Applications Bureau for Licensing (CAB). Therefore, the correction was late and civil penalties are being assessed for (1) day in the amount of $100 per day. The Deficiency was cleared at the time of the visit and a clearance letter was provided to Licensee.

On office visit conducted with the licensee, California Code of Regulations (CCR) Section 87109(b) Transferability of License was cited and POC was to inform the licensing agency in writing of the sale and acknowledgment of missed deadline. This was due by the POC due date 1/24/2024. As of this date 2/2/2024 the department has not received the written statement to clear the deficiency. Therefore, the facility will be issued civil penalties for failure to correct in the amount of $100 per day for (9) days. The licensee provided the LPA with a written statement at the time of the visit, and provided the clearance letter to them.

An exit interview was conducted where this report along with LIC421FC were reviewed and provided to Licensee, Esta Hobbs.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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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