336427421-1-25-2024-18-AS-CNWE-CZTVSQ-20240125154156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336427421
Report Date: 01/25/2024
Date Signed: 01/25/2024 03:42:05 PM

Document Has Been Signed on 01/25/2024 03:42 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:	TEMPLE GREEN		FACILITY NUMBER:	336427421
ADMINISTRATOR:	HOBBS, ESTA		FACILITY TYPE:	740
ADDRESS:	40086 TEMPLE COURT		TELEPHONE:	(951) 249-9234
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 0	DATE:	01/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:48 PM
MET WITH:	Esta Hobbs, Licensee		TIME COMPLETED:	03:48 PM

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On 1/25/2024, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Licensee, Esta Hobbs who was informed of the purpose of the visit. At the time of visit there was zero #0 staff and #0 residents present. Esta informed LPA that facility is not currently operating, however, still want to maintain its license. LPA toured the facility inside and out with Esta Hobbs.

Tour included:

Kitchen: LPA toured the kitchen and observed the kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lid. Fridge, freezer, and all need appliances were present and shown to be in working condition and clean.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 70 degrees Fahrenheit.

Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medication: Medications will be stored in a medication cabinet. The first aid kit was complete.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

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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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: TEMPLE GREEN	FACILITY NUMBER: 336427421
	VISIT DATE: 01/25/2024

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Bathroom: LPA toured three #3 resident bathrooms and observed bathrooms to be clean and equipped with grab bar. There is also a good number of personal toiletries available. The hot water measured at 120 degrees Fahrenheit. Night lights were maintained throughout the facility.

Bedroom: LPA toured six #6 out of #6 resident bedrooms and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs, and lighting. LPA observed resident bedroom #3 ceiling was broken. Esta stated the ceiling will be fixed by February 2024.

Garage: LPA tour the garage and observed garage to be clean.

Laundry: Washing machine and dryer are all in good repair and sufficient for the census. Cleaning supplies are stored away in the laundry room.

Backyard: LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. LPA observed facility pool was adequately secured.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and Freezer are large enough to accommodate required perishable foods.

Records: All required postings were posted near the entryway and throughout the facility. The administrator certificate expires on 9/27/2024.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Esta Hobbs.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024

LIC809 (FAS) - (06/04)

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