374602941-1-30-2026-18-AS-JSRS-DQU2WE-20260130164524

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602941
Report Date: 01/30/2026
Date Signed: 01/30/2026 04:45:29 PM

Document Has Been Signed on 01/30/2026 04:45 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:	HJJ HOME #1		FACILITY NUMBER:	374602941
ADMINISTRATOR/ DIRECTOR:	BOYER, HOWARD D.		FACILITY TYPE:	735
ADDRESS:	28441 MEADOW GLEN WAY WEST		TELEPHONE:	(760) 580-8575
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY: 4		CENSUS: 4	DATE:	01/30/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:47 PM
MET WITH:	Howard Boyer, Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:50 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 01/30/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA met with Licensee, Howard Boyer and explained the nature of the visit upon entry into the facility. The facility serves four ambulatory developmentally disabled adults; ages 18 to 59 years old and is approved RHCP for diabetes. At the time of the visit, all four (4) residents were present. The facility was inspected inside and out. The facility is a two story home with four (4) bedrooms and three (3) bathrooms. Two (2) residents have private bedrooms and two (2) residents share one bedroom. There is also a master bedroom for the owner. The facility was observed to be spacious and clean. Staff records were reviewed. All staff reviewed have criminal record clearances and are appropriately associated to the facility. Resident bedrooms are clean and appropriately furnished. All smoke and carbon monoxide detectors were tested and found operable. Food supplies are sufficient with two day perishable and seven day non-perishable food items. Emergency food and water are stored underneath the stairwell, laundry machines are in the garage and are operable. Hot water was measured in the residents' bathroom and deemed safe at 117 degrees. LPA observed all toxic chemicals and other hazards secured and inaccessible to residents. Medications are centrally stored in the living room cabinet. Furniture in the home is in good repair. Outdoor space is free of hazards. LPA inspected resident records and all required documents were current. P&I monies are kept in a locked cabinet in the living room and are maintained separately from facility funds. LPA inspected medications and medications appear to be dispensed appropriately according to the physician's orders. The facility is completing emergency drills on a semi-annual basis. The last drill was conducted on 09/01/2025. Licensee fees are up to date. During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to the Licensee.

NAME OF LICENSING PROGRAM MANAGER: Rikesha Stamps
NAME OF LICENSING PROGRAM ANALYST: Jacqueline Shaw Ross
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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