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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880652
Report Date: 08/23/2024
Date Signed: 08/26/2024 08:26:43 AM


Document Has Been Signed on 08/26/2024 08:26 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:ABSOLUTE DESERT CARE IFACILITY NUMBER:
331880652
ADMINISTRATOR:CARLOS, CHANNEFACILITY TYPE:
740
ADDRESS:73137 SOMERA RDTELEPHONE:
(760) 636-1910
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 5DATE:
08/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Staff Sandy LapuzTIME COMPLETED:
04:00 PM
NARRATIVE
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On 8/23/24 Licensing Program Analyst's (LPAs) Valerie Flores, Ferrer Sabarias and Abdoulaye Zerbo conducted an unannounced one (1) year required visit. LPA's were granted entry by caregiver, Viridiana Cisneros, who was informed of the purpose of visit. At the time of the visit there were two (2) staff and five (5) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA's observed the following during today's visit:

The physical plant is a single-story structure that contained five (5) resident bedrooms and three (3) bathrooms. Two (2) bedrooms and (1) bathroom were observed in the garage. Licensee was not able to produce proper permits or an accurate facility sketch of the facility. The facility has a dining room, kitchen, living room, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There is a gated pool located in the backyard. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Water temperature measured at 111.5-degree Fahrenheit meeting within the required limits. Dishes and utensils were in sufficient supply and in good repair. Extra linen and towels were observed to be sufficient in supply and in good repair. Disinfectant, knives, and other sharp items were observed in a locked cabinet. According to staff, there are no firearms or ammunition on the premises. Resident bedrooms had the required bedding, furniture, and lighting. The dual smoke and carbon monoxide detectors were tested and were observed to be operable. Facility maintained the centrally stored medication in a locked closet in the hallway near the entrance.


Additional information documented on an LIC809-C...

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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 4


Document Has Been Signed on 08/26/2024 08:26 AM - It Cannot Be Edited

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: ABSOLUTE DESERT CARE I
FACILITY NUMBER: 331880652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87208(a)
Plan of Operation
(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not providing LPA the Plan of Operation during the time of visit which poses a potential health, safety or personal rights risk to persons in care. There was a lock observed on the facilities refrigerator located in the kitchen. LPA was not able to verify if the locked refrigerator was a part of the Plan of Operation.
POC Due Date: 09/06/2024
Plan of Correction
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Licensee is emailing the POC to LPA
Type B
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above due to two (2) bedrooms and one (1) bathroom were built in the garage which poses a potential health and safety for the person residing in the facility. Per the facility sketch, there shall not be any persons residing in the garage and no additional structures were documented on the facility sketch.
POC Due Date: 09/06/2024
Plan of Correction
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Licensee is emailing the POC to LPA
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 08/26/2024 08:26 AM - It Cannot Be Edited

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: ABSOLUTE DESERT CARE I
FACILITY NUMBER: 331880652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87456(a)(2)
Evaluation of Suitability for Admission
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in three (3) out of five (5) did not have pre-appraisals on file which poses a potential health, safety or personal rights risk to persons in care. LPA requested that Licensee send them via email during the time of visit and Licensee was not able to produce due to not having computer access.
POC Due Date: 09/06/2024
Plan of Correction
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Licensee is emailing the POC to LPA
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: ABSOLUTE DESERT CARE I
FACILITY NUMBER: 331880652
VISIT DATE: 08/23/2024
NARRATIVE
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Staff files reviewed included but not limited to criminal record clearance, required annual training's, and valid first aid/CPR certification. Resident files included signed admission agreements and physician reports. Pre-appraisals were missing for resident (R1), R2, and R3. Facility sketch, personal rights, see something say something and emergency disaster plan is posted on a wall near the entrance. During today's visit, LPA's cited for deficiencies.

An exit interview was conducted, and a copy of this report was reviewed and provided to staff Sandy Lapuz.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4