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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426771
Report Date: 03/11/2021
Date Signed: 03/11/2021 04:54:23 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:ACCURO HOMESFACILITY NUMBER:
336426771
ADMINISTRATOR:LESLEY VANNOYFACILITY TYPE:
740
ADDRESS:6764 BLACK FOREST DRIVETELEPHONE:
(951) 479-5260
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 4DATE:
03/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Leslie Vannoy, AdministratorTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Amy Goldenberg is conducting a case management visit for the purpose of a health, safety and welfare check. LPA met with the facility administrator Leslie Vannoy. There are four (4) residents currently residing in the home which LPA spoke with. Two of which are receiving hospice services. During this visit LPA reviewed four (4) resident records and toured the facility. LPA found the facility records to be well organized and Leslie had digital copies of records as well. LPA observed the facility is at a comfortable temperature for the residents and is maintained in a clean and organized manner. There are no items present which would pose a hazard to residents. Locked storage areas are available for medications, for toxic substances and for sharp items such as knives and scissors. LPA tested the water in the resident bathing areas at 113.9 degrees F and tested the smoke alarms and found them functioning. Fire extinguishers were charged and mounted, dated 02/2021. Based on LPA observations during this visit there are no identified immediate hazards present to the residents in care.

This report was reviewed with and a copy was provided during an exit interview with the facility representative.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
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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