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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604307
Report Date: 07/29/2023
Date Signed: 07/29/2023 02:47:37 PM

Document Has Been Signed on 07/29/2023 02:47 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:WALK OF LIFE, ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
374604307
ADMINISTRATOR:LEWIS-BARRETO, ANNABELLEFACILITY TYPE:
735
ADDRESS:168 EVVIA COURTTELEPHONE:
(707) 439-1816
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 6CENSUS: 6DATE:
07/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:William Lewis, AdministratorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility to conduct an annual review. LPA was greeted at the door by House Manager, Maria Shriver. Administrator, William Lewis arrived shortly. LPA explained the purpose of the visit. The facility is approved for five (5) non-ambulatory clients with one (1) bedridden room. There were six (6) clients and three (3) staff present at the facility. LPA Shaw Ross conducted staff and client interviews and toured the facility inside and out.

The facility is a one story, four(4) bedroom, two(2) bathroom home. All bedrooms were observed to be clean and appropriately furnished. Bathrooms observed appeared to be clean and contained required items. The water temperature was tested and measured at 105 degrees Fahrenheit. Indoor temperature was 70 degrees. The smoke and carbon monoxide alarms were tested and found operable. LPA Shaw Ross observed one fully charged fire extinguisher. The kitchen was observed to be fully stocked with a sufficient amount of food and supplies. Emergency food and water was stored in the garage. The knives were stored in a locked drawer in the kitchen. P&I funds are kept locked in a cabinet in the garage and are kept separate from facility funds. Chemicals and hazardous items are also stored in a locked cabinet in the garage. There are no firearms and/or ammunition present or stored in the facility. The backyard was observed to be fully fenced with plenty of shade and is free of hazards. There were no pools of bodies of water observed in the facility's premises.

LPA Shaw Ross reviewed facility files and records. Background clearances and training were observed to be current. Administrator's license is current and expires 10/28/2024. Client records were reviewed and observed to be complete and current. P&I funds were inspected and no co-mingling of funds were observed.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: WALK OF LIFE, ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 374604307
VISIT DATE: 07/29/2023
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Medication and first aid kits are stored in a locked medication cart in the living room. Medications were reviewed and appear to be dispensed appropriately according to physician's orders. The facility is completing emergency drills regularly. The last emergency drill was conducted 7/6/2023. The facility was found to be clean and in good repair with no pathway obstructions.

During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to Administrator William Lewis.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2023
LIC809 (FAS) - (06/04)
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