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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209068
Report Date: 10/06/2021
Date Signed: 10/13/2021 08:59:00 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR:MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:82CENSUS: 75DATE:
10/06/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:44 PM
MET WITH:Carolyn Sorruste, Residential Care Manager (RCM) TIME COMPLETED:
06:15 PM
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On 10/06/2021, Licensing Program Analyst (LPA) L. Salazar arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by RCM. Facility has one entry/exit point. Visitor log-in/temperature check observed at the entrance of the facility. LPA toured the facility inside and out.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. LPA observed social distancing is being maintained in the common and dining areas. Bathrooms had a trash cans with lids. Signs promoting social distancing, cough/sneeze etiquette, and hand-washing observed. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. Cleaning and PPE supplies were checked. LPA observed 30-day PPE and that was stored in a storage in Memory Care unit and resident's 30 day medication supply. Common and resident bathroom sinks are well stocked with liquid soap for hand washing. Food supply was checked and there appeared to be an adequate supply. Residents wear masks when away from the facility. Resident’s files have updated emergency contact information.

Facility Mitigation plan has been received. Infection control procedures described in the plan were observed and include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, staffing, PPE storage, use and training, and daily infection control procedures. 66 out of 75 residents are fully vaccinated. 43 out of 49 staff members are fully vaccinated. Through LPA’s observations, documentation review and interview with licensee, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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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