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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602176
Report Date: 09/11/2024
Date Signed: 09/11/2024 12:09:10 PM

Document Has Been Signed on 09/11/2024 12:09 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:TWAY FAMILY HOMEFACILITY NUMBER:
374602176
ADMINISTRATOR/
DIRECTOR:		TWAY, PATRICIAFACILITY TYPE:
735
ADDRESS:3111 PENVIEW DRTELEPHONE:
(760) 726-3162
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 6CENSUS: 6DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:ADMINISTRATOR, CHEYANNE CONSTABLETIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On September 11, 2024, Licensing Program Analyst (LPA), Venus Mixson, made an unannounced visit to the facility for the purpose of conducting the Required Annual inspection, and met with Administrator, Cheyenne Constable introduced herself and stated the purpose for the visit.

PHYSICAL PLANT: Facility is licensed for six and is operating at 100% six which is within the conditions and limitations of the license. Outdoor and indoor passageways are kept free of obstruction. No pool or body of water was observed on the property. According to staff, there are no known weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. Temperature was within in regulations for this time of day and the season. There was sufficient lighting throughout the facility and the Hot water tested within regulations at 110.7 degrees F. Fire extinguisher located in kitchen area has proper inspection tag last serviced 05/2024. The smoke and carbon monoxide alarms were in the green and last inspected in 2024. The interior and exterior areas of the home were observed to be clean and organized.

FOOD SERVICE: There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean. LPA observed the required two-day supply of perishable and seven-day supply of non-perishable foods.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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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: TWAY FAMILY HOME
FACILITY NUMBER: 374602176
VISIT DATE: 09/11/2024
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Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures.
Care & Supervision/Administration: Adequate staffs are present for the supervision of residents in care. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed administrator possesses an administrator certificate that they have paid for a renewal as the expiration date was 5-27-2026.

Record Review and Resident/Staff Files: LPA reviewed two staff files and reviewed the facility's staff schedule. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Four two residents files were reviewed and possessed all required paperwork.



MEDICATION: Medications were reviewed for two Residents in care. All medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to clients in care. Medications and medication documentation was observed to be well organized and monitored.

Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.



An exit interview was conducted where a copy of this report was provided to Administrator, Cheyenne Constable.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024
LIC809 (FAS) - (06/04)
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