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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881224
Report Date: 12/13/2021
Date Signed: 12/13/2021 12:21:24 PM

Document Has Been Signed on 12/13/2021 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:ARAGON MANORFACILITY NUMBER:
331881224
ADMINISTRATOR:ARAGON, MARIELAFACILITY TYPE:
740
ADDRESS:33785 TAMERRON WAYTELEPHONE:
(951) 245-4244
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 4CENSUS: 4DATE:
12/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mariela AragonTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPAs) Melody Brown and Rohit Lama conducted an announced visit to the pending facility for a pre-licensing inspection. LPAs met with Administrator Mariela Aragon.

This facility was previously licensed as Aragon Manor (336405858) and is undergoing a change of ownership. The pending application is for a capacity of four (4) residents: four (4) non-ambulatory or three (3) non-ambulatory and one (1) bedridden in a Residential Care Facility for the Elderly. LPAs toured the facility inside and out. The following was observed, reviewed, and inspected:

The facility has 6 bedrooms, in which 3 bedrooms are designated for residents, and 3 bedrooms are designated for staff/family, 3 bathrooms, living room, kitchen, dining area, backyard, and attached garage. The physical plant, in general, was in good repair. The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. Additionally, residents and staffs’ files were locked. LPAs observed an in-ground pool in the backyard, the perimeter of pool is gated and locked.

LPAs was informed that no firearms or ammunition will be kept at facility. The Administrator/Applicant Mariela Aragon has a current Administrator's Certificate with expiration date 12/18/2022.



LPAs inspected resident bedrooms. Resident bedrooms have the required bedding and furniture. All bedrooms included clean mattresses, closet space, nightstands, dressers, and sufficient lighting. LPAs inspected resident bathrooms. The bathrooms were operating in safe and sanitary conditions. LPAs measured the hot water temperature, which measured within regulation at 108 degrees F. LPAs also observed additional linen and hygiene items for the residents. LPAs toured the kitchen. The facility had a 2-day supply of perishable food items and 7-day supply of non-perishable food items. The food was labeled with expiration dates and stored in a safe and healthful manner. The facility had a menu available for review. Dishes, glasses, and utensils were in good condition.
(continuation on LIC809C)
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARAGON MANOR
FACILITY NUMBER: 331881224
VISIT DATE: 12/13/2021
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Fire clearance was granted by the Lake Elsinore Office of the Fire Marshall for four (4) non-ambulatory or three (3) non-ambulatory and one (1) bedridden resident. There are charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. Emergency disaster plans, personal rights, and the Community Care Licensing poster were posted in a prominent area. The facility was equipped with a complete first aid kit and manual as well as emergency supplies.


LPAs inspected the backyard. LPAs observed an in-ground pool in the backyard, the perimeter of pool is gated and locked. There was a shaded area with seating. There was no obstruction on the side yard exits. The gates remained unlocked.


There was a locked and centralized storage area for medications. Cleaning supplies, toxins, and sharps were kept locked away and inaccessible to residents. Additionally, LPAs observed facility to have required single entry point for COVID screening, upon entering facility. LPAs observed required COVID signages throughout the facility, Visitation Vaccination Requirement and soap and disposable towels in bathrooms for washing hands.

The facility had a designated area for resident and staff files. The facility had working telephones for residents’ use. There was adequate seating in the common areas. LPAs observed activities for the residents such as books and games.

At this time facility has shown to have met pre-licensing requirements.

The facility was evaluated in accordance with Title 22, Division 6, Chapters 1 to ensure the health and safety of residents in care and meets regulation guidelines at this time.



No corrections are needed.

An exit interview was conducted, and a copy of this report (LIC 809) was reviewed with and provided to Administrator/Applicant Mariela Aragon.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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