331800073-9-26-2023-18-AS-SMAZ-CW2QAW-20230926120036

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800073
Report Date: 09/26/2023
Date Signed: 09/26/2023 12:01:18 PM

Document Has Been Signed on 09/26/2023 12:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	VINEYARD PLACE		FACILITY NUMBER:	331800073
ADMINISTRATOR:	ARLENE CRAWFORD		FACILITY TYPE:	740
ADDRESS:	24325 WASHINGTON AVE		TELEPHONE:	(951) 387-8410
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	82	CENSUS: 41	DATE:	09/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Arlene Crawford - Executive Director		TIME COMPLETED:	12:13 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit for an annual inspection. LPA was granted entry and met with Staff Development Director Tiffany Querido to conduct the tour of the facility. Executive Director Arlene Crawford arrived during the visit to assist. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair and were present. The facility is approved for a secure perimeter and has working auditory door alarms for residents with dementia. The outdoor area was observed to be free of hazards. The facility has two courtyards with outdoor furniture and shaded area for residents. LPA observed the fire alarm panel showed all systems normal. The smoke detector and carbon monoxide are inspected annually. LPA recorded the hot water temperature in resident bathrooms at 109.2 F and the bathrooms located throughout the hallways at 106.7 F. The facility does not contain any pools or bodies of water, firearms, or ammunition on the property. LPA observed sufficient supply of hygiene items, linens, towels and blankets. The cleaning supplies and other toxins are stored in housekeeping closets. LPA observed sufficient lighting in each bedroom as well as all appropriate furniture such as beds, chairs, night stands, lamps and closet/drawer space. Facility's restrooms were clean and operational and contained grab bars and non-skid mats in all the bathrooms.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VINEYARD PLACE	FACILITY NUMBER: 331800073
	VISIT DATE: 09/26/2023

NARRATIVE

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LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA was informed the facility receives two shipments of food a week.

Adequate staff are present for the supervision of residents during the visit. LPA reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate.

LPA reviewed five (5) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed and possessed all required paperwork.

Resident medications are stored and secured in the North medication room and South Medication room. LPA observed the facility utilizes an eMARS for documentation of the distribution of medication. LPA observed all medications listed on eMARS and all required labeling was found to be in place.

LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility conducts fire and earthquake drills monthly which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to Executive Director Arlene Crawford.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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