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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004591
Report Date: 02/15/2024
Date Signed: 02/15/2024 04:12:37 PM


Document Has Been Signed on 02/15/2024 04:12 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:CHATEAU LAKE SAN MARCOS COMMUNITY CARE CENTERFACILITY NUMBER:
372004591
ADMINISTRATOR:RICHARDSON, RENEE J.FACILITY TYPE:
740
ADDRESS:1560 CIRCA DEL LAGOTELEPHONE:
(760) 471-0083
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:15CENSUS: 8DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Renee Richardson, Administrator TIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit/annual inspection. LPA was greeted and granted entry by Administrator Renee Richardson, where LPA explained the purpose of the visit. The facility is licensed to serve fifteen (15) elderly residents ages 60 and above. The facility has an approved hospice waiver for three (3).

LPA conducted a tour of the facility the facility was observed to be clean, clutter and odor free. The passageways were clear of obstruction. LPA reviewed 4 staff files of which all 4 staff were observed to have obtained proper fingerprint clearance and to be associated to the facility. The facility has a dining room, that accommodates residents for the 3 meals served, and unlimited snacks. The main kitchen prepares the food and delivers the food to the dining room. The dining room is equipped with kitchen utensils that were found in good repair.

LPA measured the hot water temperature and was observed to be within regulatory limits of 113.8 degrees. Showers are given in the centralized shower room. The medications were observed to be locked and inaccessible to the residents in care.The facility utilities an electronic program for tracking the residents prescribed medication. LPA conducted a review of resident medication and was observed to be given according to the Physician's orders.

The smoke and carbon monoxide detectors were tested and found to be operable. The facility was observed to have the required postings. The emergency disaster drills are being conducted on a quarterly basis with the last drill being conducted 10/27/23. There are no guns or ammunition stored on grounds.

There were no deficiencies observed during today's visit. An exit interview was conducted and a copy of this report was provided to Renee Richardson, Administrator.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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