Crown Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ivashia Wright conducted an unannounced annual required visit. Upon entry, LPA was greeted by John Jacob, caregiver, and informed them of the purpose of the visit. Administrator Agnes Martinez arrived shortly after. Facility Overview: The facility is a single-story home with with five (5) residents bedrooms, three and half (3.5) bathrooms, a dinning room, a family room, an office and a kitchen area. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked under the kitchen sink and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was measured 106.1 F, meeting the department requirements. LPA observed fire extinguisher to be in compliance with the department's requirements and with an expiration date of 3/9/2027. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate which expires August 28th, 2027. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Four (4) residents files were reviewed and contained all required documentation. LPA observed first aid kit to be stored in a locked hallway closet inaccessible to residents. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in a kitchen cabinet. LPA reviewed medications for 3 (three) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 4/5/2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided to the Administrator Agnes Martinez.the state’s words, verbatim · CDSS document, Jun 3, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an announced pre-licensing inspection at the facility and met with Licensee/Administrator Agnes Martinez. Application: The inspection is a Change of ownership (CHOW) for a Residential Care Facility for Elderly (RCFE). The Murrieta Fire Department approved a fire clearance on 03-20-2025 for one (1) non-ambulatory residents and five(5) bedridden residents. Buildings and Grounds: The facility is a single story building with five(5) residents bedrooms, three and half(3.5) bathrooms, a dinning room, a family room, an office and a kitchen area. Water temperature was measured at several places averaging at 110.3 F. The interior and exterior walkways of the facility were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were in working order. There is a no pool and there are no weapons stored in the facility. Residents' bedrooms are fully furnished, and privacy is available. Outdoor areas have sufficient room for activities and leisure. A washing machine and dryer were available and in working order. The facility has a working phone witnessed by calling the phone number. Storage and Supplies: Medications will be stored in a locked cabinet in the kitchen area, and residents and staff files will be stored in the office and inaccessible to unauthorized individuals. A complete first aid kit was observed to be available. Cleaning supplies will be stored in the laundry room area. Linens, and equipment appeared to be in good repair and sufficient for the approved census. Continued 809-C.... Fire extinguishers were available and fully charged with an expiration date of February 28th, 2026. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and freezer are in working order. Sharps knives will be stored under the sink in the kitchen area, available only to authorized individuals. Forms: The following signs were observed to be posted at the facility: See something say something, Personal Rights, Emergency disaster plan, the facility sketch. The Administrator hold an Administrator's certificate with the expiration of December 29, 2025 and a CPR certification with the expiration date of August 20th, 2025. LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. The applicant will be contacted by the Regional Office to schedule COMP III. LPA determined the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and this report was discussed and a copy was provided to Licensee/Administrator Agnes Martinez.the state’s words, verbatim · CDSS document, May 13, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 COMP II Participants: Iarish Martinez CEO/ Agnes Martinez Administrator Interview Method: Telephone interview On April 2, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Apr 2, 2025