374600975-7-29-2023-18-AS-VMIN-CU7P62-20230729110136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600975
Report Date: 07/29/2023
Date Signed: 07/29/2023 11:01:51 AM

Document Has Been Signed on 07/29/2023 11:01 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	EAGLES NEST RETIREMENT RANCH		FACILITY NUMBER:	374600975
ADMINISTRATOR:	MARIA C. RICHLEY		FACILITY TYPE:	740
ADDRESS:	2100 ZACHARY GLEN LANE		TELEPHONE:	(760) 415-1252
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	6	CENSUS: 6	DATE:	07/29/2023
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	ADMINISTRATOR, MARIA RICHLEY		TIME COMPLETED:	11:12 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	On July 29, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, Maria Richley, introduced herself, and stated the purpose of the visit. LPA Mixson toured the facility and inspected the inside and outside of the facility. The facility is a single story home located at 2113 Drew Road Escondido, Ca. 92027. Physical Plant: The physical plant is clean, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of the inspection. The facility has six bedrooms, and each room has the required furniture and storage space, and sufficient lighting. All rooms were equipped with the required items as per Title 22 regulations. The hot water temperature was tested and was within regulations. The restrooms were equipped with liquid soap and paper towels. The LPA toured the kitchen, living room and the TV room. The kitchen area was clean, organized, and free or odors. One caregiver was present preparing the morning meal. All food requirements were met, the seven day supply of non perishables, and the two day supply of perishable. The LPA inspected the common areas, and the laundry room. Smoke detectors were in the green and operable. The fire extinguisher was in the green, and last reviewed for services in 2023. Carbon monoxide alarms, along with smoke detectors were observed, and were operable. CONTINUED ON 809-C

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023

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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: EAGLES NEST RETIREMENT RANCH	FACILITY NUMBER: 374600975
	VISIT DATE: 07/29/2023

NARRATIVE

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CONTINUED FROM 809

There was a locked and centralized storage closet area for medications. Medications are contained in bubble packs and are delivered by a pharmacy. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for family visitors, inside and outside, as well. LPA Mixson observed menus posted in visible areas. The LPA observed the previous Community Care Licensing (CCL), forms which are required to be available at the facility for public review for three years.

LPA Mixson reviewed four staff files, six resident files, and conducted two staff interviews and two resident interviews.

There were no observable Title 22, Division 6 Regulation violations observed and/or cited during todays visit.

An exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023

LIC809 (FAS) - (06/04)

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