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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426503
Report Date: 05/23/2022
Date Signed: 05/23/2022 12:58:09 PM

Document Has Been Signed on 05/23/2022 12:58 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:PEOPLE'S CARE TRADE WINDSFACILITY NUMBER:
336426503
ADMINISTRATOR:BAZILE, FLORENCEFACILITY TYPE:
735
ADDRESS:25290 TRADE WINDS DRTELEPHONE:
(951) 928-8444
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 4CENSUS: 4DATE:
05/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:HOUSE LEAD TARSHA FOSTERTIME COMPLETED:
01:09 PM
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On 05/23/2022 at 12:03PM Licensing Program Analyst (LPA) Venus Mixson made an unannounced visit to conduct the required annual inspection. LPA Mixson was greeted and granted entry by House Lead Tarsha Foster. LPA Mixson introduced self and explained the purpose of the visit with an emphasis on infection control.

Present in the facility were 4 clients and 4 caregivers. There are currently no cases of COVID-19 within the facility.

LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures. LPA Mixson observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of face coverings.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. LPA Mixson later discussed infection control practices and procedures with House Lead.

An exit interview was conducted, and a copy of this report, along with the LIC 811 was provided to House Lead per Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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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