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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425347
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:44:13 PM

Document Has Been Signed on 02/13/2024 02:44 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: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: 27DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Shakilla WilliamsTIME COMPLETED:
01:00 PM
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On 2/13/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Supervisor, Julieta Faleono. LPA met Administrator, Shakilla Williams. During the visit, there was 28 clients and 10 staff present.

LPA conducted a tour of the facility, reviewed random staff and client files, and conducted interviews. The facility is made up of nine (9) classrooms providing activities including gardening, exercising, games and resources. The fire alarms were not tested due to several clients' hypersensitivity. LPA reviewed the fire inspection report dated 10/31/2023, noting the fire extinguishers were serviced and smoke alarms tested and found to be operational. The facility appeared clean and free of odors. The physical plant in good repair, with indoor passageways free of obstruction. There were no bodies of water observed on the premises. LPA observed cleaning supplies, disinfectants, and Personal Protective Equipment secured in hallway closets. LPA also observed the facility has emergency food and water. Staff present have a criminal record clearance on file and a valid first aid certificate and Crisis Prevention Intervention card. LPA was informed there are no clients currently taking medication during day program hours. The facility’s last fire and earthquake drill was conducted in January of 2024.

During today's visit, LPA did not issue any deficiencies. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Williams.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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