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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423729
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:13:47 PM

Document Has Been Signed on 11/21/2024 12:13 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SEGURA'S HOME IIFACILITY NUMBER:
336423729
ADMINISTRATOR/
DIRECTOR:		THRASH, JENNETTEFACILITY TYPE:
735
ADDRESS:19378 SPIRIT TRAIL DRIVETELEPHONE:
(951) 780-8727
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 4CENSUS: 0DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Jennette Thrash AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 11/21/2024, Licensing Program Analysts(LPAs) Ferrer Sabarias and Abdoulaye Zerbo arrived unannounced at the facility to conduct an annual inspection. LPAs were greeted and granted entry by Licensee, Jeannette Thrash who was informed of the purpose of the visit. At the time of visit there was 2 staff and 0 residents present. LPAs toured the facility inside and out with Jeannette Thrash.
Kitchen: LPAs toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked safe in the pantry available only to authorized individuals. Trash cans has tight-fitting lids. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean.

Dining and Living room; LPA toured the dinning and Living room area. LPA observed area to be clean and furniture are in good condition. Temperature was 69 degrees Fahrenheit.

Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detector were tested and observed to be operational. LPA observed additional linens and hygiene items. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date 11/24/24 .

Medications: LPA observed a locked medication cabinet where medications and clients and staff files will be stored. The first aid kit was complete.

Bathroom: LPA toured hall bathroom and observed bathroom to be clean. There is also a good number of personal toiletries available for the clients. The hot water measured at 117.6 degrees Fahrenheit.


Continue on LIC809-C

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Ferrer Sabarias
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SEGURA'S HOME II
FACILITY NUMBER: 336423729
VISIT DATE: 11/21/2024
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Continued from LIC809-C.

Bedroom: LPAs toured residents bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility.

Garage: LPA tour the garage and observed garage to be clean.

Laundry: Washing machine and dryer are all in good repair and sufficient for approved capacity. Cleaning supplies are stored away in the laundry room, inaccessible to clients.

Backyard: LPAs toured the backyard and observed backyard to be clean and furniture are in good condition. The backyard was free from obstruction and the side gates remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored. Fridge and freezer are large enough to accommodate required perishable foods.

Administrator certificate expires on 3/11/2026. All required postings, were posted near the entryway and throughout the facility.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Jeannette Thrash.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Ferrer Sabarias
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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