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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881507
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:28:35 AM

Document Has Been Signed on 02/21/2025 11:28 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:PATTY'S PLACEFACILITY NUMBER:
331881507
ADMINISTRATOR/
DIRECTOR:		BARR, BOBBI JEANFACILITY TYPE:
740
ADDRESS:25079 QUEBRADA COURTTELEPHONE:
(951) 750-8656
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6CENSUS: 3DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Caretaker- James AliviadoTIME VISIT/
INSPECTION COMPLETED:
12:00 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
On 02/21/25, Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caretaker James Aliviado who was informed of the purpose of the visit. The facility has a fire clearance six (6) non-ambulatory of which 0 may be bedridden; waiver/granted for hospice care for two (2) residents.

LPA toured the facility with Caretaker and reviewed staff and resident records. During the tour, LPA observed the facility is made up of a one (1) story home with three (3) resident bedrooms, one (1) staff room, two (2) resident bathrooms, a living room, dining room, kitchen and attached garage. All resident's bedrooms had required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is also available for the residents in care. LPA observed a hallway cabinet filled with clean towels, blankets, and linen, available for the residents. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA toured the garage and observed an additional refrigerator with perishable foods. LPA noted the facility secures cleaning solutions, laundry detergent, and disinfectants in the kitchen locked cabinet under the sink. The living room was observed to have board games and other activities. The facility was observed to be in a clean condition; free of dirt, insects, rodents, and pests. Caretaker tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed one (1) charged fire extinguisher mounted throughout near the entrance, next service date is on 11/7/25. Medications are secured in a locked cabinet stored in a cabinet near the dinning room. Exit signs, emergency contact information, resident's personal rights, and complaint information are visibly posted near the entrance.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 5
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: PATTY'S PLACE
FACILITY NUMBER: 331881507
VISIT DATE: 02/21/2025
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
26
27
28
29
30
31
32
LPA reviewed staff files that included but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and updated physician reports. Facility sketch, LTCO, CCL complaint poster, license and emergency disaster plan is posted on a wall near the entrance and dinning area.

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.


SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5