<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426763
Report Date: 06/18/2021
Date Signed: 06/18/2021 02:39:46 PM

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:MICAH'S ELDERLY CARE, INC.FACILITY NUMBER:
336426763
ADMINISTRATOR:MYRNA VALENZUELAFACILITY TYPE:
740
ADDRESS:995 BOUQUET CIRCLETELEPHONE:
(951) 532-7746
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:6CENSUS: 5DATE:
06/18/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Leslie MaguyonTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Pauline Beschorner conducted an unannounced Case Management visit. LPA was greeted and granted entry by House Manager Leslie Maguyon. LPA explained the purpose of the visit and Maguyon accompanied LPA on a tour of the inside of the home.

During LPA's visit, Maguyon stated the facility was sold and is now Twin Hearts Senior Care, LLC. The annual inspection was not completed.

During today's visit no deficiencies were cited.

An exit interview was conducted, and a copy of this report was provided to House Manager Leslie Maguyon.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1