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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604368
Report Date: 07/28/2023
Date Signed: 07/28/2023 06:54:59 PM

Document Has Been Signed on 07/28/2023 06:54 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:MERAKEY - AMPAROFACILITY NUMBER:
374604368
ADMINISTRATOR:CARLY ROQUEMOREFACILITY TYPE:
737
ADDRESS:479 AMPARO DRIVETELEPHONE:
(442) 277-4554
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 4CENSUS: 3DATE:
07/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Jazmin Espinoza, AdministratorTIME COMPLETED:
07:00 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to complete the annual inspection. LPA arrived at the facility and was greeted by Amanda Thomas LVN/Case Manager. Administrator Jazmin Espinoza joined shortly. LPA toured the inside and outside of the facility. The facility is approved to serve four (4) non-ambulatory developmental disabled adults, ages 18 through 59. There were three (3) clients present and four (4) staff present.

The facility is a four (4) bedroom two and a half (2 1/2 bathroom one story home. During the inspection, LPA observed the facility to be clean and in good repair with no pathway obstruction. The residents bedrooms, bathrooms and the facility's kitchen, as well as the common areas were inspected and found to be in compliance. All required postings were posted throughout the facility. The Administrator's certificate expires on 4/21/2024. The facility does not have firearms and/or ammunition on the grounds.

The facility is appropriately furnished. The water temperature was tested and measured at 109.5 degrees Fahrenheit. Indoor temperature measured at 73 degrees. The smoke alarms and carbon monoxide alarms were tested and found operable. LPA observed three fully charged fire extinguishers. The kitchen was observed to be fully stocked with a sufficient amount of food and supplies. Emergency food and water was stored in separate area in the pantry. The knives were stored in a locked drawer in the kitchen. The medications are stored in a locked cabinet in the hallway. P&I funds are kept locked in a cabinet in the hallway and are kept separate from facility funds. Chemicals and hazardous items are also stored in a locked area.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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: MERAKEY - AMPARO
FACILITY NUMBER: 374604368
VISIT DATE: 07/28/2023
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The backyard was observed to be fully fenced with plenty of shade and is free of hazards.

LPA reviewed facility files and records. Background clearances and trainings were observed to be current. Medication was reviewed and appear to be dispensed appropriately according to physician's orders. The facility is completing emergency drills regularly.

During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of this report was reviewed with and provided to the Administrator.

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

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
LIC809 (FAS) - (06/04)
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