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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881583
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:36:45 PM

Document Has Been Signed on 10/23/2024 02:36 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:ANGEL'S HAVEN CARE ASSISTED LIVING LLCFACILITY NUMBER:
331881583
ADMINISTRATOR/
DIRECTOR:		GARCIA, RICARDOFACILITY TYPE:
740
ADDRESS:34535 RUNNING CANYON DRIVETELEPHONE:
(951) 452-1216
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 6CENSUS: 5DATE:
10/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Applicant, Ricardo GarciaTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 10/23/2024 Licensing Program Analyst (LPA), Janette Romero made an unannounced visit to the facility to conduct a pre-licensing evaluation. LPA met with Applicant, Ricardo Garcia. The Department received a change of ownership application to continue the operation of a Residential Care Facility for the Elderly, and on 4/18/2024, the facility was granted a fire clearance for six (6) non-ambulatory elderly residents.

LPA toured the facility with Caregiver, Luisa Rodriguez Escalante and reviewed records. During the tour, LPA observed the facility is made up of a one (1) story home with five (5) resident bedrooms, two (2) bathrooms, a living room, dining area, kitchen and attached garage. Caregiver, Gilberto Molina Rios tested one of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA observed two (2) charged fire extinguishers mounted in the kitchen and garage. Resident bedrooms have the required bedding, furniture, and lighting. Bathrooms are equipped with non-skid mats and grab bars in the showers. There are no bodies of water on the premises. LPA toured the kitchen and observed the facility has more than a two-day supply of perishable foods and seven-day supply of non-perishable food items, which are stored in a safe and healthful manner. Knives, scissors, and sharp instruments are secured in a locked cabinet under the kitchen sink. Cleaning solutions, hand sanitizers, and disinfectants are secured in the locked laundry room. Medications are secured in a locked file cabinet stored near the dining area. The facility has a dementia plan of operation. LPA observed operable door alarms to address any wandering behaviors. The facility has a central heating and air conditioning system with a central panel located in the hallway to control the entire home. Complaint procedures and emergency contact information is visibly posted near the front entrance.

During today's visit, LPA did not observe any issues or concerns, and there are no corrections required. Final approval of licensure will be granted by the Centralized Applications Bureau analyst. An exit interview was conducted and a copy of this report was reviewed and provided to Applicant Garcia.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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