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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881442
Report Date: 02/05/2025
Date Signed: 02/05/2025 10:32:57 AM

Document Has Been Signed on 02/05/2025 10:32 AM - 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:MURRIETA MANOR: SENIOR LIVINGFACILITY NUMBER:
331881442
ADMINISTRATOR/
DIRECTOR:
ARIZOBAL, IVANFACILITY TYPE:
740
ADDRESS:30903 LAELIA CIRCLETELEPHONE:
(760) 412-0321
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 6CENSUS: 0DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Ivan ArizobalTIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 02/5/25 Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced one (1) year required visit. LPA was granted entry by the Administrator, Ivan Arizobal, who was informed of the purpose of visit. At the time of the visit there were no residents residing at the facility. The Administrator was observed to have obtained proper fingerprint clearance and was associated to the facility.

LPA conducted a tour of the facility with Administrator Ivan Arizobal. The physical plant is a single-story structure that consisted of four (4) resident bedrooms, and three (3) bathrooms. The facility has a formal dining room, kitchen, living room, and a garage. Indoor and outdoor passageways were free of obstruction. Water temperature was measured at 105.8-degree Fahrenheit meeting the requirements. Dishes and utensils were in sufficient supply and in good repair. Knives and other sharp objects are stored in a locked cabinet in the kitchen area . Disinfectant and other cleaning solutions were observed in a locked cabinet in the laundry room. According to Administrator, there are no firearms on the premises. Resident bedrooms had the required bedding, furniture, and lighting. Smoke and carbon monoxide detectors were observed to be operable.


The facility does not have any residents and staff, therefore, there were no staff/resident files for LPA to review. The Administrator told LPA that they are planning to accept residents this year. During today's visit, LPA did not observe any immediate violations or concerns.

An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Ivan Arizobal

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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