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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423747
Report Date: 05/31/2024
Date Signed: 05/31/2024 03:46:09 PM

Document Has Been Signed on 05/31/2024 03:46 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:ROSS HOUSE, THEFACILITY NUMBER:
336423747
ADMINISTRATOR/
DIRECTOR:		ROSS, TERRIFACILITY TYPE:
735
ADDRESS:41758 LAURIE LANETELEPHONE:
(951) 652-2533
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 6CENSUS: 4DATE:
05/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Eva Jaramillo, StaffTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA), Stephanie Martinez, made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with Staff, Eva Jaramillo; she was notified of the purpose for the visit. Administrator, Deje Smith Wallace, was notified of the LPA's visit via telephone.

PHYSICAL PLANT: Clients appear to be protected against immediate hazards. Outdoor and indoor passageways are kept free of obstruction. No pool or body of water was observed on the property. According to the staff, Eva, there are no weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Hot water was tested and observed to be within regulatory requirements. Toilets, hand washing and bathing facilities were kept safe and in operating condition. Additional equipment for physically handicapped clients is available in the shared bathroom only. The smoke and carbon monoxide alarms were tested and found to be operable.

Due to insufficient time available to the LPA, a continuation visit will be conducted at a later date. This report was reviewed with staff, Eva Jaramillo, and a copy was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2024
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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