<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800108
Report Date: 09/14/2021
Date Signed: 09/20/2021 09:06:50 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:A B CARING SENIOR LIVING 2FACILITY NUMBER:
331800108
ADMINISTRATOR:CARRASCO, REBECCAFACILITY TYPE:
740
ADDRESS:470 MEADOWLARK LANETELEPHONE:
(951) 435-7592
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 6DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rebecca Carrasco, AdministratorTIME COMPLETED:
10:15 AM
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) Stephanie Torres made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. The LPA signed in and utilized hand sanitizer. The LPA was greeted by Administrator, Rebecca Carrasco. Carrasco was notified of the purpose of the visit. Present in the home during time of visit were two (2) staff as well as six (6) residents. There are currently no cases of COVID-19 within the facility.

During today's visit, the LPA toured the facility and made observations pertaining to the facility's infection control measures. The LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions. The facility has not submitted to the Department the Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report. Administrator agreed to submit the COVID-19 Mitigation Plan to the Department by 09/17/2021.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code or Regulations. An exit interview, to review this report, was conducted and a copy was provided to Carrasco.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 21