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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423972
Report Date: 03/17/2022
Date Signed: 03/17/2022 02:06:35 PM


Document Has Been Signed on 03/17/2022 02:06 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:WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCIIFACILITY NUMBER:
336423972
ADMINISTRATOR:JACQUELYN J. WHITEFACILITY TYPE:
740
ADDRESS:24068 RISTRAS LANETELEPHONE:
(951) 319-6622
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 3DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Administrator Jacquelyn WhiteTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Javina George and Venus Mixson made an unannounced visit and was greeted and granted entrance by the administrator Jacquelyn White and explained the purpose of the visit. At the time of visit there was 1 staff and 3 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPAs toured the facility and made observations regarding the infection control measures that the facility has implemented. The facility submitted their mitigation plan on 04/16/21.

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The facility will contact the resident's physician should there be event of any COVID-19 related illnesses. Administrator was also educated on the expectations should there be a positive covid case that the facility should care for the resident, as long as the resident is not in distress.

Based on the observations made during today’s visit, technical advisories are being issued as the facility staff have not been FIT tested, there is no sign in sheet or covid-19 screening for visitors. Additionally, the facility did not have an updated Emergency disaster plan available for review.

An exit interview was conducted, and a copy of this report was provided to Administrator Jacquelyn White.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0231
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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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