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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427421
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:56:59 PM


Document Has Been Signed on 09/25/2024 01:56 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 GREENFACILITY NUMBER:
336427421
ADMINISTRATOR:HOBBS, ESTAFACILITY TYPE:
740
ADDRESS:40086 TEMPLE COURTTELEPHONE:
(951) 249-9234
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 0DATE:
09/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee, Esta HobbsTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to conduct a case management visit. LPA contacted Licensee, Esta Hobbs over the phone and met with Zohaib Alvi who were informed of the purpose of the visit. During the time of the visit, LPA conducted interviews.

Upon parking outside of the facility, LPA met with Zohaib Alvi of RNZ Quality Care. LPA interviewed him and he left shortly after. Alvi stated Licensee was at the facility and could meet with LPA. LPA attempted to gain entry to the home and contacted the licensee Esta Hobbs over the phone who informed they were not in town and no other person could give LPA access to the home. LPA reviewed the report with licensee over the phone. Due to not being able to inspect the home on this date, an immediate civil penalty of $500 is being issued.

The case management visit is in response to written notification from the licensee received on August 15, 2024 of change in facility ownership to RNZ Quality Care becoming effective September 15, 2024. LPA contacted the licensee on 9/4/2024 who revealed there are no clients in care, no current staff other than the licensee who resides in the home, and would ensure the RNZ Quality Care would submit an application for change of ownership with (5) days of the effective transition date. The licensee also acknowledged the need to associate any new staff to the facility and to notify the department if any resident is accepted during the transition process.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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 4


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: 09/25/2024
NARRATIVE
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LPA contacted RNZ Quality Care’s Ruze Rahman, Zohaib Alvi, and Mohammad Rahman and licensee Esta Hobbs on 9/4/2024 and 9/23/2024 and had not received confirmation of submitting an application to the department’s applications Bureau. On today’s date LPA spoke with Zohaib Alvi and requested documentation of proof. Zohaib stated they had not submitted the application for change of ownership.

Therefore, the facility failed to ensure an application for change of ownership was submitted within the required time frame. The Health and Safety Code is being cited on the attached LIC809D. A collaborative plan of correction was created with licensee Esta Hobbs. LPA reviewed and provided this report, LIC809D and appeal rights.

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/25/2024 01:56 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2024
Section Cited
HSC
1569.161(b)

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(b) Except as provided in subdivision (e)… (2) The prospective buyer shall submit an application for a license…within five days of the acceptance of the offer by the seller. This requirement was not met as evidenced by:
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The licensee and new ownership agreed to send LPA mail receipt and documents mailed to Central Applications Bureau by the POC due date.
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Based on interview and record review, an application for change of ownership was not submitted to the department within the required time frame. This poses a potential health, safety, or personal rights risk to residents in care.
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The licensee and new ownership agreed to send written statement that no residents will be accepted into the facility until an application is submitted to the department. This is also due by the POC due date.

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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.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4


Document Has Been Signed on 09/25/2024 01:56 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2024
Section Cited
HSC
1569.33(a)

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(a) Every licensed residential care facility for the elderly shall be subject to unannounced inspections by the department. The department shall inspect these facilities as often as necessary to ensure the quality of care provided.
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The licensee agreed to write a statement of understanding of the section cited and submit to LPA by the POC due date.
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This requirment was not met as evidenced by:Based on LPA's inability to conduct a facility inspection on 9/25/2024, Licensee unable to give LPA access to the home. This posses an immediate health safety or personal rights risk.
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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.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4