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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881347
Report Date: 02/19/2025
Date Signed: 02/19/2025 11:09:29 AM

Document Has Been Signed on 02/19/2025 11:09 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:KELLY'S ALMAGRO VILLAFACILITY NUMBER:
371881347
ADMINISTRATOR/
DIRECTOR:		WELKER, KELLYFACILITY TYPE:
740
ADDRESS:1889 ALMAGRO LANETELEPHONE:
(619) 504-5049
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 6CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Caregiver, Joanna DizonTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 2/19/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Caregiver, Joanna Dizon who was informed of the purpose of the visit. The facility has an approved hospice waiver for six (6) and a fire clearance to serve six (6) non-ambulatory elderly adults.

LPA toured the facility with Caregiver Dizon and observed the facility is made up of a one-story home with six (6) resident bedrooms, two (2) resident bathrooms, a visitor restroom, kitchen, dining room, and attached garage. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. No bodies of water were observed on the premises. Indoor and outdoor passageways were free of obstruction. The facility has more than two-day supply of perishable foods and seven-day supply of non-perishable foods, which are stored in a safe and healthful manner. Medications are secured in a locked medication room near the kitchen. LPA toured the garage and observed an operating laundry washer and dryer along with additional incontinent supplies, cleaning solutions/disinfectants, food and water. Caregiver Dizon tested one of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility. The facility's certificate of liability insurance expires on 3/1/2025. Staff present have a criminal record clearance and are associated with the facility. Resident files reviewed had updated physician's reports and signed admission agreements. Long Term Care Ombudsman's contact information, complaint procedures, and facility sketch are visibly posted near the front entrance and kitchen. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Caregiver Dizon.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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