Facility Evaluation Report

On March 11, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct a Pre-Licensing (CHOW), and met with lead Caregiver, June Chin. Facility records were requested and reviewed on site. The facility is licensed for five (5) Adults and is operating currently at a capacity of three (3) Adults (735).

LPA Mixson toured the facility along with Lead Caregiver, June Chin and made observations pertaining to the Pre-Licensing visit.

Physical Plant: The location is a two-story home located at 27785 Auburn LN Moreno Valley, CA. 92555. and has four bedrooms, three full bathrooms, and a half bathroom. A living room, dining room, and a kitchen, with a two-car garage. A backyard and front yard. The Moreno Valley Fire Department approved this facility for five (5) Ambulatory, zero (0)-Non-Ambulatory, and zero (0) bedridden resident, on January 16, 2025. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate is current with an expiration date of 06/20/2025. For Phillippe Chin(87303).

Medications : LPA Mixson observed medications stored, locked, and inaccessible to residents in care. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed and are operable. LPA Mixson observed the fire extinguisher, it was charged and in the green, and services 02/2025. The cleaning supplies were locked and inaccessible, along with the sharp objects. Lead Caregiver, June Chin informed the LPA there are no firearms on the premises. (87465).