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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425776
Report Date: 05/28/2021
Date Signed: 05/28/2021 02:39:17 PM

Document Has Been Signed on 05/28/2021 02:39 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:INSPIRATIONS HOME CARE VIFACILITY NUMBER:
336425776
ADMINISTRATOR:GARCIA, ROMULOFACILITY TYPE:
740
ADDRESS:1117 CARTER LNTELEPHONE:
(951) 870-5676
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 6CENSUS: 0DATE:
05/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Noelia GarciaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Pauline Beschorner arrived at the facility on May 28, 2021 at 2:00 PM to conduct an Annual/Required Visit. Licensee Noelia Garcia answered the door and allowed LPA into the facility. Garcia stated there are currently no residents in care as the facility is undergoing some updates. There have not been residents in the facility since the pandemic started. Garcia accompanied LPA on a tour of the inside and outside of the facility and the following was observed:

LPA observed all COVID signs posted in the facility. LPA observed a sufficient supply of PPE. LPA inspected the inside and outside of the facility and verified there are no clients in care. LPA toured the bedrooms, the bathrooms, and went over the facilities infection control procedures with Garcia. Garcia is prepared once the facility is updated to have residents in care.

An exit interview was conducted and a copy of this report was provided to Licensee Noelia Garcia. No technical violations or citations are being given at this time.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Pauline Beschorner
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2021
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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