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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425347
Report Date: 04/25/2022
Date Signed: 04/25/2022 11:15:11 AM

Document Has Been Signed on 04/25/2022 11:15 AM - 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:KAISER ADULT BEHAVIORAL CENTER TEMECULAFACILITY NUMBER:
336425347
ADMINISTRATOR:SOUZA, SHARIFACILITY TYPE:
775
ADDRESS:27496 COMMERCE CENTER DR STE HTELEPHONE:
(951) 225-2632
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: 60CENSUS: 0DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Program Supervisor- Joseph BiglayTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA), Janira Arreola made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Program Supervisor Joseph Biglay, who was informed of the purpose of the visit. At the time of visit there was 3 staff and 0 clientss present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings at the facility. A single entry point was designated where symptoms screenings and temperature checks occur daily for all visitors and staff. The facility had a plan in place to monitor symptoms regularly for any changes in condition. The facility had an adequate amount of hand hygiene supplies (soap, hand sanitizer, paper towels) in all 5 restrooms. Facility is currently using Google Meet to mitigate the spread of COVID-19 and conduct their program virtually. There is 1 designated isolation room and a plan in place to monitor and attend to those in the isolation room. LPA observed a sufficient 30-day supply of PPE equipment. The facility also has a designated infection control lead and a plan in place to clean and disinfect the highly touched surfaces. LPA observed Mitigation plan posted throughout there facility.

There were no deficiencies noted at the time of the visit.

An exit interview was conducted, and a copy of this report was reviewed and provided to Program Supervisor, Joseph Biglay.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2022
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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