<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424108
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:10:33 PM

Document Has Been Signed on 07/24/2024 12:10 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:MCCARTHY HOUSEFACILITY NUMBER:
336424108
ADMINISTRATOR/
DIRECTOR:		PIERCE, LISAFACILITY TYPE:
735
ADDRESS:83403 CARIBE AVENUETELEPHONE:
(760) 972-4254
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 6CENSUS: 6DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:02 AM
MET WITH:Lisa Pierce, licenseeTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Seo Jeon and Licensing Program Manager(LPM) Rikesha Stamps conducted an unannounced annual visit. Upon arrival, LPA was granted entry and met with and the licensee, Lisa Pierce who was informed of the purpose of the visit. At the time of the inspection, there was one(1) staff members and zero(0) client present.

The facility is a single-story home with 3 bedrooms and 2 bathrooms, complete with an attached garage. Notably, there are no pools or other bodies of water on the premises, and no firearms or dangerous weapons are stored at the facility. The clients served are adults between the ages of 18 and 59.


During the inspection, LPA observed the hand washing stations in the facility restrooms and kitchen, which were equipped with hand hygiene supplies and hand washing signs. Additionally, LPA observed the presence of personal protective equipment (PPE) and cleaning supplies for regular facility maintenance. LPA reviewed the facility’s infection control plan, which met department requirements. LPA reviewed staff records and found that all staff had infection control training.

LPA inspected the client bedrooms and staff office. The physical plant, including floors, windows, and doors, were found to be clean. Fixtures and furniture were well maintained. The outdoor area was hazard-free, with outdoor furniture and a shaded space for clients. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to clients. Smoke and carbon monoxide detectors were operational, and the hot water temperature was set to 108.4 and 110.4°F. Fire extinguisher is current with an inspection of March 11, 2024.

continued on LIC809C...

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
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: MCCARTHY HOUSE
FACILITY NUMBER: 336424108
VISIT DATE: 07/24/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required two (2) day supply of perishable and seven (7) day supply of non-perishable foods.

LPA also reviewed the staff schedules showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate.

All client medication are locked in a cabinet located in the living room. LPA reviewed medications for two (2) clients and found all medication listed on MARs and all required labeling was found to be in place.



LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility performs monthly fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and dining area and first aid kit with all required items.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview was conducted where a copy of this report was provided to Licensee, Lisa Pierce.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2