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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008059
Report Date: 01/24/2025
Date Signed: 01/24/2025 12:10:40 PM

Document Has Been Signed on 01/24/2025 12:10 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:DOWNSTOWN IIIFACILITY NUMBER:
372008059
ADMINISTRATOR/
DIRECTOR:		CIAVERELLI, ELISSAFACILITY TYPE:
735
ADDRESS:232 OCEANVIEW DRIVETELEPHONE:
(760) 945-7877
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 4CENSUS: 4DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kecia Stinnet- Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Kecia Stinnett and Elissa Ciaverelli who were informed of the purpose of the visit. At the time of the visit, there were no clients present at the facility; Executive Director Kecia reported that the clients were attending the day care program. The facility has a fire clearance for four (4) ambulatory clients and serves adults ages 18 through 59 years of age. Staff present have a criminal record clearance and are associated with the facility.

LPA toured the facility and reviewed records. During the tour, LPA observed the facility is made up of a one-story home with three (3) client bedrooms, one (1) staff bedroom and three (3) bathrooms, a living room, dining room, kitchen, laundry room and attached garage. All client bedrooms had the required furniture, lighting, and closet storage. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. LPA toured the kitchen and observed the facility has a two-day supply and perishable foods and more than a seven-day supply of non-perishable foods that were observed to be properly stored and readily available. Knives and sharp instruments were secured in a locked box in the kitchen cabinet. LPA toured the garage and observed a second refrigerator and a freezer in the garage with additional perishable food. LPA reviewed random client and staff records. Client files reviewed had updated Individual Program Plans and signed admission agreement. Staff files reviewed had the Department's required training records and valid first aid/CPR certification. LPA reviewed the physical medications and Medication Administration Record for two (2) clients and did not discover any discrepancies.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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 2
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: DOWNSTOWN III
FACILITY NUMBER: 372008059
VISIT DATE: 01/24/2025
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LPA also observed that the personal hygiene supplies, laundry detergents, client files, first aid kit and Medications/PRN are stored in the laundry room locked cabinets. Clean towels, blankets, and linens for the clients stored in the client's bathroom cabinet drawers and in the cabinet located in the hallway. Emergency Plan and contact information, client's personal rights, and complaint information and infection control plan are visibly posted near the entrance.

Kecia was notified that CCLD has not received the facility's annual fee for 2025. LPA provided the Pin code# 499455 for the facility to obtain the PIN number to pay the annual fee. During this visit, Kecia paid the annual fee and confirmation # 956780.

During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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