Facility Evaluation Report

On June 14, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced Required One Year visit , and met with the Administrator, Tianya. The Facility file review was conducted in the Regional Office and additional forms were reviewed on site. The facility is licensed for four Adults, type (735), and is currently serving three Adults.

LPA Mixson toured the facility along, with the Administrator following is a summary. Physical Plant: The facility is a single-story home located at 327 Pinnacle Street, Perris, CA. 92570, and has four resident bedrooms, three bathrooms, a family room, dining area, kitchen, and an attached two-car garage. The facility land line phone number is (951) 490-4080 and it is operable.

Bedrooms : The bedrooms were furnished with the required items per Regulation. There were observable smoke alarm/carbon monoxide detectors, in accordance with California, Code of Regulation, Title 22.

Facility Bathrooms : bathrooms have a working toilet, wash basin, and were equipped with a grab bar and non-slips mats in the shower. The water temperatures tested within regulations. The facility has an sufficient supply of extra liens available to residents in care.

Kitchen : LPA Mixson observed a sufficient supply of dishes, glasses, utensils, pots, and pans. Sample menu is posted in kitchen on the side of the refrigerator. All kitchen appliance, along with the stove is operational. Refrigerator and freezer were in working condition.

Centrally Stored Medications: Medications were locked and inaccessible to the residents in care, and there was a sufficient monthly supply for the residents. LPA Mixson observed a first aid kit with required components, and it was locked and inaccessible to residents in care.