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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880593
Report Date: 08/26/2023
Date Signed: 08/26/2023 04:00:09 PM

Document Has Been Signed on 08/26/2023 04:00 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:RIVERWALK HOMEFACILITY NUMBER:
331880593
ADMINISTRATOR:ALCON, WILFREDO SFACILITY TYPE:
735
ADDRESS:4452 PONDMOOR DRTELEPHONE:
(951) 977-8503
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 4CENSUS: 3DATE:
08/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Wilfredo Alcon, Licensee/Administrator TIME COMPLETED:
04:08 PM
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to complete a comprehensive annual inspection. LPA Nickolas met with Licensee/Administrator Wilfredo Alcon and explained the purpose of the visit. Today’s inspection included a facility tour, record reviews, and interviews with staff and residents.

The facility is four (4) bedrooms and two and a half (2 ½) bathrooms of which three (3) bedrooms are used for residents in care. The facility also has kitchen/dining area, living area, outdoor seating, and attached garage. Licensed capacity is four (4).

Physical Plant: There are no obstructions to indoor and outdoor passageways. The facility temperature is 76 degrees Fahrenheit. LPA inspected resident bedrooms; each room included required furniture such as mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were functional. LPA Nickolas' observed adequate furniture and lighting throughout the facility. The hot water temperature tested within regulation at 105-degree Fahrenheit. The facility has operating smoke detectors and carbon monoxide alarms, which LPA Nickolas tested during the visit. The facility has one (1) charged fire extinguisher, that is serviced annually. LPA Nickolas observed personal rights posters, Licensing documents, and the disaster plan posted throughout the facility. LPA Nickolas observed that cleaning supplies, toxins, sharps, and other dangerous items are kept secure and inaccessible to residents in care. There was a designated storage space for client/staff files. LPA Nickolas observed medications locked and inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.

Food Service: Non-perishable and perishable food supply is sufficient in number for residents in care. The facility has a variety of food available for residents. Dishes, cups, and utensils were also appropriately stored.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: RIVERWALK HOME
FACILITY NUMBER: 331880593
VISIT DATE: 08/26/2023
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Care & Supervision: The facility staff is sufficient in number for the care and supervision of residents in care. All staff members working in the facility have criminal record clearance through the department.

Record Review: LPA Nickolas reviewed two (2) resident files for admission agreements, updated physician reports, and needs and services plans. Medications were audited randomly and appeared to be dispensed appropriately by staff members. LPA Nickolas also audited P&I funds. LPA Nickolas reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the Alcon.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2023
LIC809 (FAS) - (06/04)
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