371881469-9-19-2023-18-AS-SMAZ-CVTNDL-20230919102230

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 371881469
Report Date: 09/19/2023
Date Signed: 09/19/2023 10:22:39 AM

Document Has Been Signed on 09/19/2023 10:22 AM - 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	NEW BEGINNINGS #1, LLC		FACILITY NUMBER:	371881469
ADMINISTRATOR:	SELBURN, SHANE		FACILITY TYPE:	735
ADDRESS:	1109 BELAIR DRIVE		TELEPHONE:	(760) 645-3052
CITY:	FALLBROOK	STATE: CA	ZIP CODE:	92028
CAPACITY:	6	CENSUS: 6	DATE:	09/19/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Shane Selburn - Licensee		TIME COMPLETED:	10:37 AM

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) Sara Martinez conducted an announced visit to complete the Pre-licensing inspection. LPA met with Licensee, Shane Selburn, to complete the change of ownership for an Adult Residential Facility with a capacity of six (6) residents. The facility is a six (6) bedroom, two (2) bath home. There are six (6) client bedrooms, one staff office, kitchen/dining area, one (1) living room area, and a backyard. LPA toured the interior and exterior areas of the facility. The following were inspected: LPA observed clients bedrooms with the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, lighting, and emergency lighting. Client bathrooms had clean appliances that were operating in safe and sanitary condition and the showers contained non-slip mats and grab bars.. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. The knives and sharp objects were locked in a cabinet located in the staff office. The facility's hot was temperature was recorded at 112.7 F. The facility contains PPE equipment and hand washing supplies and hand washing signs. The washer and dryer are located in the locked staff office and has a locked cabinet for the chemicals and detergents. Client files, staff files, and medication will be located in the staff office. The facility maintains an adequate supply of clean linen and personal hygiene supply. The facility does not have any bodies of water on the property. There is a covered area with seating for the all the clients. All passageways were free from obstruction. LPA observed multiple charged fire extinguishers in the facility. The smoke detectors and carbon monoxide alarms were operational. The facility does not have any firearms and ammunition on the property.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: NEW BEGINNINGS #1, LLC	FACILITY NUMBER: 371881469
	VISIT DATE: 09/19/2023

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LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights. The facility has a posted schedule for activities and outings for the clients and a adequate amount of activities present. LPA observed multiple first aid kits with the required items and manual. The facility has working telephone for client use.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA have determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and this facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Licensees Shane Selburn.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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