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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412432
Report Date: 02/25/2022
Date Signed: 02/25/2022 11:58:21 AM

Document Has Been Signed on 02/25/2022 11:58 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:FRIENDS HOME CARE AT MORGAN VALLEYFACILITY NUMBER:
336412432
ADMINISTRATOR:RICHARD & JENNIFER FRIENDSFACILITY TYPE:
740
ADDRESS:45165 RIDEAU STREETTELEPHONE:
(951) 383-8038
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY: 6CENSUS: 5DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Richard Friend, LicenseeTIME COMPLETED:
12:05 PM
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On 02/25/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Caregiver Asuncion Buscaino, and explained the purpose of the visit. Administrator Richard Friend arrived shortly after. At the time of visit there was 2 staff and 5 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA discussed the expectation for the facility to submit their LIC808 mitigation plan to have on file and for review for staff, residents and visitors. Administrator agreed that the facility's mitigation plan will be submitted no later than Tuesday 3/1/22, by 5:00pm.

LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. Upon entry there is a hand washing station and temperature screening for staff and visitors.

Per Administrator the facility will contact the resident's physician should there be event of any COVID-19 related illnesses. The facility staff are using EPA approved cleaners to clean and disinfect the facility at minimum of three times a day.

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 Administrator Richard Friend.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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