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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424327
Report Date: 08/22/2024
Date Signed: 08/22/2024 03:14:26 PM

Document Has Been Signed on 08/22/2024 03:14 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:WALKER RANCH RESIDENTIALFACILITY NUMBER:
336424327
ADMINISTRATOR/
DIRECTOR:
WALKER, DANAFACILITY TYPE:
735
ADDRESS:15575 GORRION COURTTELEPHONE:
(951) 924-8837
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY: 4CENSUS: 3DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Administrator Adrienne WalkerTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 8/22/24 Licensing Program Analyst's (LPAs) Valerie Flores and Abdoulaye Zerbo conducted an unannounced one (1) year required visit. LPA's were granted entry by caregiver, Bernardita Acuna, who was informed of the purpose of visit. At the time of the visit there were one (1) staff, Administrator and three (3) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA's observed the following during today's visit:

LPA's conducted a tour of the facility with staff member, Bernardita. The physical plant is a two-story structure that contained three (3) resident bedrooms and three (3) bathrooms. The facility has a dining room, kitchen, family room. living room, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Water temperature measured at 120.5-degree Fahrenheit meeting within the required limits. Dishes and utensils were in sufficient supply and in good repair. Extra linen and towels were observed to be sufficient in supply and in good repair. Disinfectant, knives, and other sharp items were observed to be in a locked cabinet. According to staff, there are no firearms or ammunition on the premises. Resident bedrooms had the required bedding, furniture, and lighting. The smoke and carbon monoxide detectors were tested and were observed to be operable. Facility maintained the centrally stored medication in a locked closet near the entrance.



Staff files reviewed included but not limited to criminal record clearance, required annual training's, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, appraisals, IPP, P&I log. Medical records reviewed showed no discrepancies. Facility sketch, personal rights, see something say something and emergency disaster plan is posted throughout the facility. During today's visit, LPA's did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator, Adrienne Walker.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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