<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413103
Report Date: 11/29/2022
Date Signed: 09/07/2023 04:50:53 PM

Document Has Been Signed on 09/07/2023 04:50 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, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME:PLAN-IT LIFE TEMECULA HOUSEFACILITY NUMBER:
336413103
ADMINISTRATOR:EDWARD RICHARDS IIFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Joe Jones, AdministratorTIME COMPLETED:
04:15 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 the above date, Licensing Program Analyst (LPA) Erika Lopez and Licensing Program Manager (LPM) Jennifer Smith conducted an annual inspection.

A physical plant inspection was completed and included the following checks: The facility is currently under repair and there are no clients in care. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children’s recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order with the exception of Bedroom #2 which smoke detector is removed. The fire extinguisher is properly charged and serviced. LPAs observed the facility has all required forms Grievance Procedures, Visitation Policies, Personal Rights form, Facility License, Menu and Foster Care Ombudsman poster but they are currently not posted due to construction. Medications are locked and centrally stored in the staff office. Individual beds were observed with mattresses in good repair. LPA observed that there is a supply of linens for number of beds available. Due to construction, the beds are not made. Bedroom #1 has a broken dresser and Bedroom #2 has three drawers for two clients which requires additional drawer space. Outlets in the client bedrooms and tv room were missing outlet covers at time of inspection and were repaired on this date. The hot water in the client’s bathroom was measured to be 127 degrees. The kitchen trash can did not have a tight fitting lid at time of inspection. The dishwasher door is dented and the dishwasher is not operating.

SUPERVISORS NAME: Jennifer Smith
LICENSING EVALUATOR NAME: Erika Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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
CCLD Regional Office, 3737 MAIN ST., SUITE 600
RIVERSIDE, CA 92501
FACILITY NAME: PLAN-IT LIFE TEMECULA HOUSE
FACILITY NUMBER: 336413103
VISIT DATE: 11/29/2022
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
26
27
28
29
30
31
32
interviews. The facility employs 1 facility manager and 9 direct care staff that are used in accordance with regulatory requirements. Licensee currently has Mental Health Program Approval through 7/23/23. Licensee has obtained National Accreditation through CARF. The Accreditation is valid through 9/30/23. Licensing fee payments have been paid and there is currently a balance of 0.

LPA discussed the following with the Administrator: Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. LPA discussed procedures for Child and Family Team (CFT) meetings, including an overview of required Core Services and Supports.

Due to time constraints the personnel files will be reviewed on a later date. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions.

No deficiencies were noted in the areas during time of inspection. Technical violations were issued for Operations, Physical Plant and Disaster Preparedness. Upon completion of construction and prior to clients being placed licensee will notify CCL. A copy of this report was given and explained to Administrator Joe Jones and appeal rights were given and explained.
SUPERVISORS NAME: Jennifer Smith
LICENSING EVALUATOR NAME: Erika Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2