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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426731
Report Date: 05/29/2026
Date Signed: 05/29/2026 01:14:54 PM

Document Has Been Signed on 05/29/2026 01:14 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:BRILLIANCE PLACEFACILITY NUMBER:
336426731
ADMINISTRATOR/
DIRECTOR:		SUZETTE MANALANSANFACILITY TYPE:
735
ADDRESS:1947 BRILLIANCE LANETELEPHONE:
(951) 294-0356
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY: 6CENSUS: 4DATE:
05/29/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Maria Theresa Javier, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On May 29, 2025, Licensing Program Analyst (LPA), Ahliah Sharp arrived at the facility unannounced to conduct the Required Annual Inspection and met with House Manager (HM) Maria Theresa Javier. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for six ambulatory adults and is currently operating at a capacity of four adult residents.

The facility is a single-story five (5) bedroom home, three (3) bathroom; one of each being designated for staff. LPA toured the facility along with HM and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises.

Physical Plant: The facility phone number is (951) 350-0300 and it is operable. LPA observed the residents’ bedrooms; each equipped with required furniture as per Title 22. LPA inspected facility bathrooms, and the hot water temperature tested within regulations at 113 degrees F, and the kitchen tested at 119.6. The bathrooms, bedrooms and kitchen were all clean, appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher, that was last tested August 2025. LPA observed required postings such as "If you See Something, Say Something,” the "Personal Rights." The cleaning supplies and sharp items were locked and inaccessible to the residents in care at the time of this visit. There was a designated storage space for residents and staff files, and it was locked and inaccessible to residents in care.

Continued on LIC(809C...

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Ahliah Sharp
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/29/2026 01:14 PM - It Cannot Be Edited


Created By: Ahliah Sharp On 05/29/2026 at 12:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BRILLIANCE PLACE
FACILITY NUMBER: 336426731

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1507(c)(1)(A)
General Provisions
(1) For regional center clients the following shall apply: (A) An individualized health care plan, which may be part of a client's individual program plan, shall be prepared for each client by a health care team that shall include the client or his or her designee if the client is not able to participate in planning his or her health care, the client's primary care physician or nurse practitioner or other health care professional designated by the physician or nurse practitioner, the licensee or licensee's designee, any involved social worker or regional center worker, and any health care professional designated to monitor the client's individualized health care plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of four resident's files, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/05/2026
Plan of Correction
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Provide proof of agreement, or porof of discharge of resident.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Jazmond D Harris
NAME OF LICENSING PROGRAM MANAGER:
Ahliah Sharp
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2026


LIC809 (FAS) - (06/04)
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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: BRILLIANCE PLACE
FACILITY NUMBER: 336426731
VISIT DATE: 05/29/2026
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Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean; the furniture is in good condition. The facility cooling system and other appliances were operable currently at the time of this visit.

Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked.

Care & Supervision/Administration: Adequate staff are present for the supervision of residents in care. Floor plans, telephone numbers and personal rights were observed posted in the facility. The listed administrator possesses a current administrator’s certificate with an expiration date of 10/06/2026, Suzette Manalansan.

Records Reviewed and Resident/Staff Files: LPA reviewed staff and resident files and reviewed the facility's staff schedule. The staff files reviewed had criminal clearance and updated training, along with First Aid Certification. Resident files reviewed possessed required paperwork, including updated TB tests. One of the resident’s files was incomplete. They did not have the admission agreement, LIC602, consents etc. LPA inquired about the missing documents and was told the resident was new, and shortly after their arrival, they already notified the facility of their intent to leave due to finding another facility. LPA notified HM of the importance of always having the completed documentation on hand and being available to remain in compliance of health and safety requirements. A deficiency was issued with a plan of correction established.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan was posted. LPA observed the last fire drill met the department standards and was conducted on April 25, 2026.

Infection Control: LPA was not provided with the facility's infection control plan and was told it was not at the facility at time of inspection. HM called Licensee to request it and licensee stated it could be made available by close of business. LPA notified HM of the importance of always having it on grounds. Due to prior record review of the facility, LPA was able to identify that the facility has had one in year’s past. LPA reminded HM to notify Licensee of the importance to keep on site.

An exit interview was conducted where a copy of this report was discussed and given to HM Javier.

NAME OF LICENSING PROGRAM MANAGER: Jazmond D Harris
NAME OF LICENSING PROGRAM ANALYST: Ahliah Sharp
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC809 (FAS) - (06/04)
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