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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800117
Report Date: 12/23/2022
Date Signed: 12/23/2022 09:49:39 AM

Document Has Been Signed on 12/23/2022 09:49 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:A PERFECT CHOICE FAMILY HOMEFACILITY NUMBER:
331800117
ADMINISTRATOR:DAWSON, GARRYFACILITY TYPE:
740
ADDRESS:10844 MEADOW CREST CTTELEPHONE:
(951) 406-1269
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 6CENSUS: DATE:
12/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:TIME COMPLETED:
09:55 AM
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the A Perect Choice Family Home unannounced for the annual inspection with a focus on infection control. Upon arrival, it was discovered that the facility is enclosed behind a secure gate. LPA contacted the facility to make staff aware of LPA's visit. Staff member agreed to meet LPA outside.

Administrator Garry Dawson, (Admin.) arrived at the front gate wearing face mask to greet LPA. LPA introduced self and stated the purpose of the visit. LPA was granted entry into facility. Admin. reported at this time there are no residents in care. LPA had temperature taken and signed in. LPA observed signs for infection control above the designated COVID station. Station included hand sanitizer and PPE made available upon entry. Admin. reports that he and the house manager currently reside in the facility.

During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. Facility observed to be orderly and free of clutter. 2 Living Room areas included adequate seating. LPA observed sufficient hand hygiene supplies and paper products in each restroom. The designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a mitigation plan in place which follows Community Care Licensing guidelines for when and how long to test staff and clients for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. LPA observed 6 potential resident rooms which were adequately furnished including sufficient lighting and call lights. Medication Room is a designated closet in hallway. Closet was observed to be labeled and secure. Fire and Carbon Monoxide alarms tested and found to be operational. Fire Extinguisher located in kitchen fully charged. Signs for licensing policy, house rules and activities posted throughout facility. Kitchen equipped with a number of secure cabinets for sharp objects and chemicals. Facility includes sizeable backyard. No pools or bodies of water observed. Areas included storage sheds and fire pit both secure behind gate.

Based on the observations made during today’s visit, there were no deficiencies cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2022
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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