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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800063
Report Date: 10/07/2022
Date Signed: 10/07/2022 10:27:10 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/07/2022 10:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 93DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stephanie OdenTIME COMPLETED:
10:36 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero made an unannounced visit to conduct an annual inspection, with emphasis on infection control. LPAs met with Administrator Stephanie Oden and explained the purpose of today’s visit. Administrator accompanied LPAs on a tour of the facility.

LPAs toured the facility and made observations pertaining to the facility’s infection control measures. LPAs observed signage throughout the facility for proper cough etiquette, proper hand washing procedure, and/or social distancing guidelines. The bathrooms were stocked with hand soap and paper towels. Facility has sufficient hand hygiene supplies, cleaning, and disinfecting. The staff working at the facility were all properly wearing face masks. LPAs requested to inspect the facility's Personal Protective Equipment (PPE) supply. The facility has a full thirty (30) day supply of PPE such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer. LPAs observed one central entry point and a sign-in has been designated for screening that includes temperature and symptom checks. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the client's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. LPAs observed no health and safety concerns at the time of visit.

No deficiencies were cited during today’s visit
An exit interview was conducted, and a copy of this report was discussed and provided to Administrator Stephanie Oden.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie IbarraTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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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