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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880940
Report Date: 08/12/2023
Date Signed: 08/12/2023 06:38:46 PM


Document Has Been Signed on 08/12/2023 06:38 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:ENJOYCARE-PECANFACILITY NUMBER:
361880940
ADMINISTRATOR:BOLING, NIRMALA JOYFACILITY TYPE:
740
ADDRESS:11599 PECAN WAYTELEPHONE:
(909) 253-1355
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 6DATE:
08/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:52 PM
MET WITH:Susan Fries, Administrator TIME COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to complete a comprehensive annual inspection. LPA Nickolas met with Administrator Susan Fries and explained the purpose of the visit. Today’s inspection included a facility tour, records review, and interviews with staff and residents.

The facility is five (5) bedrooms, two (2) full bathrooms, and four (4) half (1/2) bathrooms that connect to four (4) out of five (5) bedrooms. The facility also has kitchen, dining room, den, living area, attached garage, and covered out door seating. Licensed capacity is six (6).

Physical Plant: The facility operates at the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility temperature is 76 degrees Fahrenheit. LPA inspected resident bedrooms; each room included required furniture such as mattresses, nightstands, storage space, chairs, and sufficient lighting; bathrooms were clean, and appliances were functional. LPA Nickolas' observed adequate furniture and lighting throughout the facility. The hot water temperature tested within regulation between 105.2 and 117.1 degrees. The facility has operating smoke detectors and carbon monoxide alarms, which LPA Nickolas tested during the visit. The facility has two (2) charged fire extinguishers, that are serviced annually by the state Fire Marshal. LPA Nickolas observed personal rights posters, Licensing documents, and the disaster plan posted throughout the facility. LPA Nickolas observed that cleaning supplies, toxins, sharps, and other dangerous items are kept secure and inaccessible to residents in care. There was a designated storage space for client/staff files. LPA Nickolas observed medications locked and inaccessible to residents in care. LPA Nickolas observed various types supplies in the backyard. However, the administrator stated that the facility was in the process of placing those items into the storage shed. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.

Food Service: Non-perishable and perishable food supply is sufficient in number for residents in care. The facility has a variety of food available for clients. Dishes, cups, and utensils were also appropriately stored.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2023
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 32


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ENJOYCARE-PECAN
FACILITY NUMBER: 361880940
VISIT DATE: 08/12/2023
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Record Review: LPA Nickolas reviewed three (3) client files for admission agreements, updated physician reports, and needs and services plans. LPA Nickolas reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings.

No deficiencies were cited during today's visit. LPA observed no apparent health and safety concerns at the time of visit. An exit interview was conducted where this report was discussed, and a copy of this report was provided to Fries at the conclusion of the inspection.


SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2023
LIC809 (FAS) - (06/04)
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