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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604260
Report Date: 01/17/2025
Date Signed: 01/17/2025 12:26:40 PM

Document Has Been Signed on 01/17/2025 12:26 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:WEAVER'S TWIN OAKS VILLAFACILITY NUMBER:
374604260
ADMINISTRATOR/
DIRECTOR:		WEAVER, TONYAFACILITY TYPE:
740
ADDRESS:2115 TWIN OAKS VALLEY ROADTELEPHONE:
(760) 798-4141
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 6CENSUS: 6DATE:
01/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Administrative Assistant, Julianmarie CruzTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 1/17/2025, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, Romelita Galapon who was informed of the purpose of the visit. Administrative Assistant, Julianmarie Cruz arrived during the visit and was also informed of the purpose of the visit. The facility has a fire clearance to serve six (6) non-ambulatory elderly residents, of which one (1) may be bedridden. The facility also has an approved hospice waiver for six (6) and LPA was informed three (3) residents are currently receiving hospice services at the facility.

LPA toured the facility with Caregiver Galapon. LPA observed the facility is made up on a one (1) story home with six (6) resident bedrooms, two (2) bathrooms, a living room, kitchen, dining room and attached garage. Indoor and outdoor passageways were free of obstruction. LPA did not observe any bodies of water on the premises. During tour of the kitchen, LPA observed the facility had more than a two-day supply of perishable foods and seven-day supply of non-perishable foods, all stored in a safe and healthful manner. Knives are secured in a locked kitchen drawer. Resident bedrooms had the required bedding, furniture, and lighting. Bathrooms had grab bars and non-skid mats in the showers. Medications are secured in a locked medication closet near the front entrance. Cruz tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility. Cleaning solutions are secured in the locked garage. The living room fireplace is adequately screened, making it inaccessible to residents in care. The facility's certificate of liability insurance expires on 8/30/2025. Staff present have a criminal record clearance and are associated with the facility. Resident files reviewed had updated physician's reports and all Departmental required records. The facility's last fire drill was conducted on 1/9/2025. Long Term Care Ombudsman information, complaint procedures, facility sketch, and emergency phone numbers are visibly posted near the front entrance. 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 Cruz.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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