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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880648
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:03:51 AM


Document Has Been Signed on 08/07/2024 11:03 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:CARING HEARTS FOR ELDERLYFACILITY NUMBER:
331880648
ADMINISTRATOR:AGRESOR, MAY-ANNFACILITY TYPE:
740
ADDRESS:73560 WOODWARD DRTELEPHONE:
(760) 333-2760
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:6CENSUS: 4DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Fida Agresor, caregiverTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), Seo Jeon, made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was greeted and allowed to enter the facility to conduct the inspection. LPA was met with Fida Agresor, caregiver, and she was notified of the purpose for the visit.

Infection Control: The LPA observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures.

PHYSICAL PLANT: The Licensee is operating the facility within the conditions and limitations specified on the license. Outdoor and indoor passageways are kept free of obstruction. No pool or body of water was observed on the property. According to staff, there are no known weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Hot water was tested at 115.5 degrees F. Fire extinguisher located in kitchen area has proper inspection tag. The smoke and carbon monoxide alarms were tested and found to be operable. The interior and exterior areas of the home were observed to be very clean and safe.

FOOD SERVICE: There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean. . LPA observed the required 2-day supply of perishable and 7-day supply of non-perishable foods.

Continued on LIC809C...

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo JeonTELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CARING HEARTS FOR ELDERLY
FACILITY NUMBER: 331880648
VISIT DATE: 08/07/2024
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Care & Supervision/Administration: Adequate staffs are present for the supervision of clients. Floor plans, telephone numbers and personal rights were found in the facility. The listed administrator, possesses an administrator certificate that they have paid for a renewal as the expiration date was 5-27-2026.

Record Review and Resident/Staff Files: LPA reviewed (3) staff files and reviewed the facility's staff schedule. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Four (4) client files were reviewed, and possessed all required paperwork.



MEDICATION: Medications were reviewed for two(2) clients in care. All medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to clients in care. Medications and medication documentation was observed to be well organized and monitored.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.



An exit interview was conducted where a copy of this report was provided to administrator, May-Ann Agresor.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo JeonTELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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