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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602357
Report Date: 07/25/2023
Date Signed: 07/25/2023 02:57:49 PM

Document Has Been Signed on 07/25/2023 02:57 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:JONATHON BOARD & CARE HOMEFACILITY NUMBER:
374602357
ADMINISTRATOR:MARILOU MANRIQUEFACILITY TYPE:
735
ADDRESS:677 JONATHON PLACETELEPHONE:
(760) 294-7981
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 6DATE:
07/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Marilou Manrique, AdministratorTIME COMPLETED:
02:57 PM
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Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced annual visit. LPA met with the Caregiver Cyd Pace at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) ambulatory residents. There are 6 residents living at the facility. The Administrator Marilou Manrique later arrived.
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 77 degrees; residents' main restroom water temperature read at 105.1 degrees; there were no bodies of water on premises; there was sufficient lighting and mattress pads in all of the residents' bedrooms; fire alarm and smoke carbon monoxide detectors were in working order. Facility does not house firearms and/or ammunition on grounds.
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. There is also emergency food supply for both residents and staff.
(Continued on LIC809-C)
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2023
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: JONATHON BOARD & CARE HOME
FACILITY NUMBER: 374602357
VISIT DATE: 07/25/2023
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(Continued from LIC809)
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. Administrator has completed a written admission agreement, current medical assessment and needs and service plan with each resident. Licensee handles resident cash resources and PPI and has documentation for all resident's spending with receipts. Administrator Certificate is current. Last disaster drill was held on 07/05/23.
Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Administrator Marilou Manrique and a copy of this report was printed Signature below confirms receipt of these rights.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023
LIC809 (FAS) - (06/04)
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