<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881491
Report Date: 06/10/2024
Date Signed: 06/10/2024 02:54:43 PM

Document Has Been Signed on 06/10/2024 02:54 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:CARE INTEGRATIONFACILITY NUMBER:
331881491
ADMINISTRATOR/
DIRECTOR:
NWAPA, CHARLESFACILITY TYPE:
740
ADDRESS:29862 SEA BREEZE WAYTELEPHONE:
(310) 346-5354
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 6CENSUS: 0DATE:
06/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:34 PM
MET WITH:Applicant, Charles NwapaTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility in order to conduct a prelicensing inspection. LPA met with applicant Charles Nwapa.

The facility is seeking an initial license for a residential care facility for the elderly, with capacity of (6). Approved for for (6) non ambulatory residents on the first floor only. The facility does not have a pool or firearms. The home is a two story home with (4) bedrooms and (3) bathrooms down stairs.LPA conducted a walk through of the interior and exterior of the facility. The bedrooms have all the required furniture and linens. LPA observed the hallway lights and the carbon monoxide detectors were in good working condition. The outdoor area was free of any hazards and an emergency exit. The kitchen had the ability to prepared food is a clean and safe environment and possessed the required food items . LPA observed areas were the staff and resident files would be kept as well as locked areas designated for medication, sharp objects, and cleaning supplies. The hot water temp was measures at 122F in the resident shower and 129F in the resident sink. Applicant agreed to have the water heater adjusted to 105F to 120F. The facility has a land line at (951) 309-8015.

The licensee agreed to obtain and send LPA proof of the following item:
- Hygiene items, such as washing soap for (6) residents
- 1-800-let us no posting
- Shaded outdoor area for residents
- Activity materials
- Emergency food supply

The applicant agreed to sent the LPA the above items by 6/14/2024 in order to proceed in the prelicensing process. An exit interview was conducted with the applicants, and copy of this report was reviewed and provided to them.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1