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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880575
Report Date: 06/19/2024
Date Signed: 06/19/2024 01:18:29 PM

Document Has Been Signed on 06/19/2024 01:18 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NEW LIFE SENIOR INDEPENDENT LIVINGFACILITY NUMBER:
331880575
ADMINISTRATOR/
DIRECTOR:		WYLIE, EDWARDFACILITY TYPE:
740
ADDRESS:25247 CORTE ORANADATELEPHONE:
(951) 691-8060
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 3CENSUS: 1DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Licensee, Michelle BrannTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 6/19/2024, Licensing Program Analyst (LPA) Janette Romero arrived and conducted an unannounced annual inspection. LPA was greeted and granted entry by Licensee, Michelle Brann. The facility has a fire clearance for three (3) ambulatory elderly residents.

During today's visit, there was one (1) resident and one (1) staff present. LPA toured the facility with Licensee. During the tour, LPA observed the facility is made up of a two-story home with three (3) resident bedrooms and two (2) resident bathrooms, a kitchen, dining room, living room and attached garage. The facility has an in-ground spa that is not gated. LPA was informed the current resident is independent. LPA interviewed Resident 1 (R1) who corroborated they were independent. LPA reviewed R1's Physician's Report (LIC601) which noted R1 is ambulatory, able to leave the facility unassisted, manage their own finances and medications, has the capacity to bathe, dress, groom, and feed themselves and care for their own toileting needs. Sharps and knives are not locked due to the resident being independent. Medications are stored in a case on a kitchen counter-top. LPA toured the kitchen and observed food is stored in a safe and healthful manner. The facility has more than a 2-day supply of perishable food and 7-day supply of non-perishable food items. Licensee tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA observed charged fire extinguishers mounted throughout the facility. Staff and resident files are secured in a file cabinet stored upstairs.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed with and provided to the Licensee.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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