Pebble Brook Senior Home Care

Type of visit: Required - 1 Year

On August 26, 2026, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to conduct the Annual Inspection and met with Administrator, Winston Falcon. Facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for six Elderly Residents and is currently operating at the capacity of six Elderly Residents. For a 740 facility type. The facility is operating within the scope of its license. LPA Mixson toured the facility along with Administrator, Winston Falcon and made observations pertaining to the Annual visit. LPA inspected the facility inside and outside. There were no obstructions or debris to the indoor or outdoor passageways observed currently at the time of this visit. Additionally, there were no bodies of water seen on the premises. The facility is a single-story facility located at 33722 Pebble Brook Circle, Temecula CA. 92592 Facility phone number is(951) 303-0253 and it is operable. LPA Mixson observed residents’ bedrooms, and each was furnished as per Regulations and Title 22. LPA inspected the facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA observed required postings such as "If you See Something, Say Something,” and the "Personal Rights." The cleaning supplies and sharp items were locked and inaccessible to the residents. There were designated storage spaces for the residents’ and staff’s files, and it was locked. LPA observed audible alarms on the exit doors throughout the facility. There are no pools or bodies of water. Administrator advised LPA that there are no firearms or ammunition. LPA observed three fire extinguishers that were serviced on 08/20/2026 Western Fire Co. INC. Fire and disaster drills are current and occur quarterly. Last drill met regulations and was conducted by Administrator. LPA observed the kitchen to be clean and free of odor. Food supplies are sufficient to meet Title 22 requirements. Medications were locked and inaccessible to residents in care. Additionally, there were a sufficient supply of medication. There were no documented errors observed on the centrally stored medication forms, and medications were stored in their original containers at the time of the visit. The facility has two caregivers on site at the time of the visit. The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at the time of this visit. Administrator informed LPA there were safety lights for night throughout the facility. There were adequate staff present for the supervision of residents in care. The floor plans, telephone numbers and personal rights were found posted in the facility. LPA reviewed staff files and the facility's staff schedule. Staff files reviewed comprise required documents. The resident files reviewed had the essential paperwork as per Regulations at the time of this visit. LPA observed the facility training binder and the binder was organized. LPA reviewed the facility's emergency and disaster plan as well as the disaster training binder. An exit interview was conducted. A copy of this report was reviewed and given to Winston Falcon, Administrator.the state’s words, verbatim · CDSS document, Aug 26, 2026

Type of visit: Required - 1 Year

On 09/11/24 at 10:20am Licensing Program Analyst (LPA) Javina George to conduct an unannounced annual visit 1 year required visit. LPA was greeted an granted entry by Caregiver Maria Guiterrez, where LPA explained the purpose of the visit. The Administrator Winston Falcon had accompanied a resident to an appointment and arrived at 11:32am. The facility is approved for six (6) bedridden residents, aged 60 and older. The facility has an approved dementia plan of operation and a hospice waiver for 4 residents. There are currently (2) residents receiving hospice services, in addition to (2) residents receiving home health services. LPA conducted a tour of the interior and exterior areas of the facility. The facility is a single story home consisting of 5 resident bedrooms, and 3 bathrooms, laundry room, living room, kitchen, garage and backyard. The resident bedrooms beds were observed to have clean linens, a chest of drawers, and night stand. The facility was observed to be clean, and clutter free. The hot water temperature was tested and measured 112-113 degrees Fahrenheit within regulatory limits. The facility has (2) fully charged fire extinguishers, with the tags in tact. The medications are stored in a locked cabinet in the hallway, across from the laundry room. The smoke and carbon monoxide detectors were tested and observed to be operable. The facility conducts emergency disaster drills on a quarterly basis, the last drill was conducted in June 2024, a drill is due by the end of the month in order to remain in compliance. LPA conducted a records review and observed for both staff and residents. All staff present were observed to have obtained criminal record clearance and to be associated to the facility, as well as to possess valid CPR certification. The administrator Winston was observed to have a valid administrator's certificate that expires 07/24/25. The resident files had the required documentation such as admissions agreement, medical and medical assessment. The facility food supply was observed to meet the requirements of a 2 day supply of perishable and a 7 day supply of non perishable food items. Based on today's inspection no deficiencies were issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report was provided to Winston Falcon, Administrator.the state’s words, verbatim · CDSS document, Sep 11, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 12:32 PM to conduct an unannounced annual visit. LPA met the Maria at door and was granted entry. The Administrator Winston Falcon arrived at 12:49 PM. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) bedridden residents with 5 residents in care. The facility has an approved dementia plan of operation and a hospice waiver for 4 residents. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety: The facility temperature read at 73 degrees. The facility consists of 5 resident bedrooms, and 3 bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with tv, lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 108.6 degrees within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the hallway and inaccessible to the resident. The facility and has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, hospice documentation, client rights, and admissions agreement. (Continued on LIC809-C) (Continued from LIC809) Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook, and the facility documents the resident’s medication and in compliance with physician’s orders and regulations. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 09/03/23. The facility has emergency supply of food and water. Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Administrator Winston Falcon and a copy of this report was printed Signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 28, 2023