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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800081
Report Date: 05/18/2021
Date Signed: 05/19/2021 07:52:59 AM

Document Has Been Signed on 05/19/2021 07:52 AM - 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:BUSMAN RESIDENTIAL CARE LLCFACILITY NUMBER:
331800081
ADMINISTRATOR:READE, JOHNFACILITY TYPE:
740
ADDRESS:27892 BUSMAN ROADTELEPHONE:
(951) 888-9512
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 6CENSUS: 5DATE:
05/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:John Reade, LicenseeTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced visit to the facility for the purpose of the annual inspection. LPA was granted entry by Norma Reade, Licensee and met with John Reade, Licensee.

The facility currently has 5 residents. The facility is a two story, six bedroom, three bath home with a living room, dining room, family room downstairs and bonus room upstairs. The resident bedrooms have a bed, dresser and appropriate lighting.

LPA observed the food supply and verified the facility to have the required 2 days perishable and 7 days non-perishable supply. The residents medications are locked and stored in a medication cart in the living room. Chemicals are locked and stored in the laundry room. The smoke/carbon monoxide detectors were tested and are operable.
Adults in the home have required Criminal Background Clearance Check and are associated to the facility.

LPA discussed a room addition that was inspected by LPA Bejarano on May 9, 2019. Licensee states a fire clearance was obtained at that time. In addition Licensee states a annual fire inspection was completed the week of May 10, 2021. Additional follow up will be required to confirm the fire clearance. If a current fire clearance is unavailable, a new clearance will be requested by the Department.

No deficiencies were observed or cited at this time. An exit interview was conducted and a copy of this report was reviewed with and provided to Licensee, John Reade.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Deborah Mullen
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2021
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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