374601847-7-31-2023-18-AS-CGOH-CU9NCN-20230731102102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601847
Report Date: 07/18/2023
Date Signed: 07/31/2023 10:21:07 AM

Document Has Been Signed on 07/31/2023 10:21 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:	SECURE SENIORS		FACILITY NUMBER:	374601847
ADMINISTRATOR:	SANDY KRASOVEC		FACILITY TYPE:	740
ADDRESS:	836 EAGLES NEST GLEN		TELEPHONE:	(760) 746-5123
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	16	CENSUS: 15	DATE:	07/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:13 PM
MET WITH:	Sandy Krasovec		TIME COMPLETED:	03:42 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	Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the Administrator Sandy Krasovec at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility follows California Code of Regulations, Title 22, Division 6. Facility is approved for four (16) ambulatory residents. The Facility is also approved for locked perimeter fenced gate. Physical Plant: front entrance, interior and surrounding exterior were clean and in good repair with no pathway obstruction; doorway alarms were in working order; facility temperature read at 76 degrees; residents' restroom water temperature read at 122.5 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all the residents' bedrooms; fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds. Infection Control Plan: The facility has an approved infection control plan that outlines hand washing procedures, handling of residents and bodily fluids and disposal of such items. The facility maintains personal protective equipment and first aid supplies.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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: SECURE SENIORS	FACILITY NUMBER: 374601847
	VISIT DATE: 07/18/2023

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Food Services: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. The facility had 3 refrigerators and 2 freezers upstairs and 1 refrigerator and 1 freezer downstairs and enough emergency food for both residents and staff.
Medication/Facility Records: Medications were observed to be labeled and in a locked place that is inaccessible to residents. All staff subject to a criminal record review obtained fingerprint clearance and/or an exemption. Staff responsible for direct care and supervision have current First Aid / CPR training. The Administrator has completed a written admission agreement, current medical assessment and needs and service plan with each resident. Waivers are in place and meet said terms. The Administrator does not handle resident cash resources. Last disaster drill was held on 06/12/23.
Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Administrator Sandy Krasovec, and a copy of this report was printed Signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

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