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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800173
Report Date: 06/04/2021
Date Signed: 06/04/2021 12:21:20 PM

Document Has Been Signed on 06/04/2021 12:21 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MEGGINSON PLACE IIFACILITY NUMBER:
331800173
ADMINISTRATOR:RACELIS, JANETTEFACILITY TYPE:
740
ADDRESS:11330 LOMBARDY LANETELEPHONE:
(951) 363-8767
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6CENSUS: 4DATE:
06/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Janette RacelisTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Christine Le and Anna Bueno conducted an unannounced visit to the facility for an annual inspection. LPAs met with administrator Janette Racelis.

LPAs toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detectors. Cleaning supplies, medications, and sharps were kept in a safe and locked place. Cleaning supplies were kept under the kitchen sink and in the garage. Medications were kept in a locked cabinet. Sharps were stored in a secured area. The facility had a complete first aid kit and manual. LPAs observed two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The facility menu was available for review. The resident bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items. LPAs toured the resident bathrooms. LPAs measured the hot water temperature in the bathrooms. The hot water temperature measured at 110 degrees F. LPAs also observed emergency supplies.

LPAs observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, residents, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents. LPAs observed hand sanitizer throughout the facility and a 30 day supply of PPE. All residents have at least a 30 day supply of medications. LPAs observed that all emergency contact information for the residents have been updated.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Christine Le
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2021
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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