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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881488
Report Date: 02/26/2024
Date Signed: 02/26/2024 10:17:39 AM

Document Has Been Signed on 02/26/2024 10:17 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:HOME OF PURPOSE ESCONDIDOFACILITY NUMBER:
371881488
ADMINISTRATOR:LEGASPI,ALYSSA GRACE ROMERFACILITY TYPE:
740
ADDRESS:1240 PINECREST AVENUETELEPHONE:
(858) 231-5710
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 0DATE:
02/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Applicant, Jason and Alyssa LegaspiTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility in order to conduct a prelicening inspection. LPA met with applicants Jason, Alyssa and Gerramy Legaspi.

The facility is seeking an initial license. The facility will be licensed as a residential care facility for the elderly, with capacity of (6). Approved for clearance for (4) non ambulatory and hospice waiver for (2) residents. The facility does not have a pool or firearms. The home is a one story home with (3) bedrooms and (3) bathrooms.

LPA conducted a walk through of the interior and exterior of the facility. The bedrooms have all the required furniture, and required hygiene supplies, and linens. LPA observed the hallway lights and the carbon monoxide detectors were in good working condition. The outdoor area was free of any hazards and had a shaded area for residents and an emergency exit. The kitchen had the ability to prepared food is a clean and safe environment and possessed the required food items . LPA observed areas were the staff and resident files would be kept as well as locked areas designated for medication, sharp objects, and cleaning supplies. The hot water temp was measures at 120F. The facility has a land line at (760) 975-3119.

There are no objections for the applicant to proceed in the prelicensing process. An exit interview was conducted with the applicants, and copy of this report was reviewed and provided to them.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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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