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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603230
Report Date: 03/06/2023
Date Signed: 03/06/2023 12:46:53 PM

Document Has Been Signed on 03/06/2023 12:46 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:ROYAL CREST RANCH HOMEFACILITY NUMBER:
374603230
ADMINISTRATOR:VERZOSA, DIONISIAFACILITY TYPE:
735
ADDRESS:2628 ROYAL CREST DRIVETELEPHONE:
(760) 658-6891
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 5DATE:
03/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Dionisia Verzosa, LicenseeTIME COMPLETED:
12:55 PM
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On March 6, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Caregiver, Susan Jacobsen who was informed of the purpose of visit. Susan called Licensee, Dionisia Verzosa who arrived at the facility shortly after. At the time of visit there was 2 staff and 5 residents present. LPA toured the facility inside and out with Susan Jacobsen.

Tour included:

Kitchen; LPA toured the kitchen and observed food are stored in a safe and healthful manner. LPA observed kitchen knives and cleaning solutions adequately secured under the kitchen sink. LPA inspected the fire extinguisher in the kitchen and found it to be in compliance and record to be up to date.

Dining: LPA toured the dining area. LPA observed dining area to be clean and furnitures in good condition.

Livingroom: LPA toured the Livingroom area. LPA observed Livingroom area to be clean and furnitures in good condition. Temperature was 74 degrees Fahrenheit.

Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction.

Laundry room; LPA inspected the laundry room and observed additional linens and hygiene items.

Continue on LIC809C

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROYAL CREST RANCH HOME
FACILITY NUMBER: 374603230
VISIT DATE: 03/06/2023
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Continued From LIC809,

Medications: LPA observed Medications were labeled and stored in separate bins inside of a locked closet and are distributed according to physician orders. The first aid kit was complete.

Bathroom; LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 115 degrees Fahrenheit

Bedroom; LPA toured five #5 out of #5 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility. Resident #1 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 115 degrees Fahrenheit. There was Carbon monoxide & smoke detector in all residents bedroom. Carbon monoxide & smoke detector were tested and functioning properly.

Garage; LPA tour the garage and observed garage to be clean.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents.

Records: LPA reviewed four #4 out of #4 staff file and five #5 out of #5 residents’ file. All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 11/30/2023.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Dionisia Verzosa.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC809 (FAS) - (06/04)
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