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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880986
Report Date: 01/10/2025
Date Signed: 01/10/2025 01:37:29 PM

Document Has Been Signed on 01/10/2025 01:37 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:HONORS WAY CARE HOMEFACILITY NUMBER:
331880986
ADMINISTRATOR/
DIRECTOR:		VALDEZ, DIANA DFACILITY TYPE:
740
ADDRESS:26818 HONORS WAYTELEPHONE:
(562) 338-5574
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 6CENSUS: 4DATE:
01/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Diana Valdez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the home. The LPA was allowed entrance into the facility and met with Administrator, Diana Valdez. The LPA informed Valdez of the purpose for the visit. The inspection included the following:

Food Service: The LPA inspected the facility's kitchen areas and food supply. The LPA observed all food to be of good quality. All readily perishable foods and beverages capable of supporting rapid and progressive growth of micro-organisms were stored in covered containers at appropriate temperatures. Soaps, detergents, cleaning compounds and similar substances were stored in areas separate from food supplies. All kitchen areas were kept clean and free of litter, rodents, vermin, and insects.

Physical Plant: The facility consists of four (4) resident bedrooms, three (3) bathrooms, a kitchen and two (2) dinning areas, a living room area, a sitting room area, a garage and storage spaces, and a yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Administrator Valdez, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways were kept free of obstruction and are free of debris and other trash. There are grab bars for toilets and showers used by residents. One smoke detector and one carbon monoxide device were tested by staff and were observed to be in operating condition. The facility was kept clean, organized and free of any odors.

Record Review: Staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Training on dementia care, postural supports, restricted health conditions, hospice and medication administration was observed on file. Resident files had admission agreements, medical assessments, and other required records on file. The licensee appears to be operating the facility within the conditions specified on the license. The facility currently has an approved Hospice Waiver for two (2) residents; and there are currently two (2) residents in care receiving hospice services.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HONORS WAY CARE HOME
FACILITY NUMBER: 331880986
VISIT DATE: 01/10/2025
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There is an emergency disaster plan in place. The licensee (HONORS WAY CARE HOME LLC) is a current and active corporation. The LPA observed current liability insurance on file, which expires 03/04/2025.

Medication Review: The LPA inspected resident medications. Medications were observed to be well organized and inaccessible to unauthorized individuals. Centrally stored medication destruction records were observed on file.

Administrator Valdez agreed to provide the LPA with a copy of the current liability insurance, staff schedule, and resident roster.

An exit interview was conducted with Administrator Valdez, in which this report was reviewed, and a copy was provided. No citations were issued at time of inspection.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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