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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881258
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:32:42 PM

Document Has Been Signed on 04/22/2022 03:32 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:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331881258
ADMINISTRATOR:KNAUER, KURTFACILITY TYPE:
740
ADDRESS:27350 NICOLAS ROADTELEPHONE:
(951) 308-1988
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 98CENSUS: 89DATE:
04/22/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Executive Director Kurt KnauerTIME COMPLETED:
03:40 PM
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On today's date 4/22/22 Licensing Program Analyst (LPA) Javina George conducted an unannounced annual required licensing inspection. LPA met with Executive Director Kurt Knauer and explained the purpose of the visit.
An overall tour of the facility was conducted of the interior and exterior. The inspection was focused on the infection control practices that the facility has implemented.

LPA reviewed the facility’s Plan for Epidemic Outbreak/COVID-19 Mitigation Plan Report (LIC 808) that was revised and dated 02/10/2022. In addition the facility has a safety coordinator binder that includes any covid related training's, and staff vaccination statuses and FIT testing information.

The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808 as evidenced by: LPA observed one central entry point for universal entry screening. LPA observed for the facility staff to be wearing the appropriate face coverings (surgical masks). The facility also had hand sanitizer/hand washing stations readily available throughout the facility.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was provided to Executive Director Kurt Knauer.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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