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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602941
Report Date: 01/09/2025
Date Signed: 01/09/2025 10:52:36 AM

Document Has Been Signed on 01/09/2025 10:52 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HJJ HOME #1FACILITY NUMBER:
374602941
ADMINISTRATOR/
DIRECTOR:		BOYER, HOWARD D.FACILITY TYPE:
735
ADDRESS:28441 MEADOW GLEN WAY WESTTELEPHONE:
(760) 580-8575
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 4CENSUS: 4DATE:
01/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Licensee, Howard BoyerTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 1/9/2025, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Licensee, Howard Boyer who was informed of the purpose of the visit. The facility has a fire clearance for four (4) ambulatory clients and serves adults ages 18 through 59.

LPA toured the facility's interior and exterior. LPA observed the facility is made up a two-story home with three (3) client bedrooms, two (2) client bathrooms, a kitchen, dining room, laundry room, and attached garage. Indoor and outdoor passageways are free of obstruction. Outdoor shaded seating is available for clients in care and there were no bodies of water observed on the premises. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed two (2) charged fire extinguishers mounted in the facility that were last serviced on 9/30/2024. The facility's last fire drill was conducted on 10/6/2024. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and seven-day supply of non-perishable foods. Medications are secured in cabinet near the dining room. LPA reviewed the Record of Client's/Resident's Safeguarded Cash Resources (LIC 405) for all four (4) clients while Licensee reviewed their physical monies and no discrepancies were discovered. Disinfectants and cleaning solutions are secured in a cabinet under the kitchen sink. LPA toured the garage and observed an operable laundry washer and dryer along with an emergency supply of food and water. Client files reviewed had updated Individual Program Plans and signed admission agreements. Staff present has a criminal record clearance and a valid CPR/first aid certification. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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