<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601847
Report Date: 07/03/2024
Date Signed: 07/03/2024 03:24:27 PM


Document Has Been Signed on 07/03/2024 03:24 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:SECURE SENIORSFACILITY NUMBER:
374601847
ADMINISTRATOR:SANDY KRASOVECFACILITY TYPE:
740
ADDRESS:836 EAGLES NEST GLENTELEPHONE:
(760) 746-5123
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:16CENSUS: 15DATE:
07/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Sandy Krasovec, AdministratorTIME COMPLETED:
03:35 PM
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 7/3/24 at 1:25pm Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an 1 year required visit/annual inspection. LPA met with Administrator Sandy Krasovec, where LPA explained the purpose of the visit.

At the time of the visit were (15) residents and (5) staff present. The facility is licensed to serve 16 non ambulatory elderly residents, age 60 and above. 2 of whom may be bedridden in bedrooms 9 or 10 only. There is an approved hospice waiver for (5), as well a locked perimeter fenced gate approved. There are currently 4 residents receiving hospice services.

The facility is two story home consisting of 11 bedrooms and bathrooms. The facility was observed to be clean and clutter free. The medications, sharps and hazardous items were observed to be locked and inaccessible to residents in care. There are no pools or bodies of water on the premises, or known guns or ammunition. The emergency disaster drills are being conducted on quarterly basis and the last drill was on 5/31/24.

The facility has an ample supply of personal protective equipment (PPE), hygiene items, and linen. The facility was observed to have a 2 day supply of perishable and 7 day supply of non perishable food items. The facility was observed to have the required postings. The hot water temperature was measured and found to be within regulatory limits.

A review of records was conducted, resident records had medical assessments, admission agreements. The staff present were observed to have obtained criminal record clearance, and had valid CPR certification. The administrator has a valid administrator certificate.

Based on today's inspection there were no deficiencies cited.
An exit interview was conducted and a copy of this report was provided to Administrator Sandy Krasovec.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024
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 1