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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880557
Report Date: 04/26/2022
Date Signed: 04/26/2022 10:13:46 AM


Document Has Been Signed on 04/26/2022 10:13 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:RAINBOW VIEW SENIOR CARE LPA,LLCFACILITY NUMBER:
331880557
ADMINISTRATOR:LORENA ALANDYFACILITY TYPE:
740
ADDRESS:4170 RAINBOW VIEW WAYTELEPHONE:
(949) 290-8661
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:6CENSUS: 5DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Cora Eusebio - CaregiverTIME COMPLETED:
10:20 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 Manager (LPM) J. Harris and Licensing Program Analyst (LPA) V. Mixson arrived at 8:52 am on the above date to conduct the annual inspection. LPA's were greeted and granted entry by Caregiver Cora Eusebio.
LPA Mixson explained the purpose of the visit. Administrator, Lorena Alandy arrived and met with LPM and LPA in order to conduct the facility tour.

Present in the facility were 5 clients and 2 caregivers. There are currently no cases of COVID-19 within the facility.

LPM and LPA toured the facility and made observations pertaining to the facility's infection control measures. LPM and LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of face coverings. No deficiencies were observed.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. LPA later discussed infection control practices and procedures with Administrator.

An exit interview was conducted, and a copy of this report, along with the LIC 811 was provided to Administrator.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2022
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 1