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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880774
Report Date: 02/26/2024
Date Signed: 02/26/2024 03:52:00 PM


Document Has Been Signed on 02/26/2024 03:52 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:RAINCROSS AT RIVERSIDEFACILITY NUMBER:
331880774
ADMINISTRATOR:JUDITH PIERFAXFACILITY TYPE:
740
ADDRESS:5232 CENTRAL AVENUETELEPHONE:
(951) 785-1200
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:120CENSUS: 89DATE:
02/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:44 PM
MET WITH:William Lewallen TIME COMPLETED:
03:58 PM
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with Residential Care Director William Lewallen. The facility is a assisted living and memory care facility that serves elderly adults. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following:

Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. The facility does not have any pools are bodies of water. The facility does not have firearms or ammunition on their property. LPA observed passageways to be free from obstruction.



Facility contains a covered patio area with tables and chairs for residents to utilize when outdoors. Resident bedrooms and bathrooms contain a pull cord for the facility's signal system. LPA observed the signal system to be operable. LPA tested the water temperatures in resident restrooms that met Title 22 regulation requirements. LPA observed grab bars and nonskid mats and/or strips in the bathroom showers.

LPA observed the kitchen and dining room area to be clean and free of odors. Facility kitchen has the ability to prepare food in clean environment and possessed equipment in good working condition. Food supplies were sufficient with an emergency food and water supply present. Facility receives two food deliveries per week.

Cleaning supplies, disinfectants and toxins are kept in areas separate from food and are inaccessible to residents and are locked within the housekeeping carts and janitorial supply store rooms. Facility contains PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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: RAINCROSS AT RIVERSIDE
FACILITY NUMBER: 331880774
VISIT DATE: 02/26/2024
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Medication is centrally stored in the Assisted Living medication room and Memory Care medication room and are locked and inaccessible to residents in care and are administered according to their physician's instructions. Facility utilizes an electronic Medication Record Administration (eMAR) when distributing prescribed medication to the residents.

LPA reviewed five (5) staff files and training. All staff have criminal record clearance and updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed and possessed all required paperwork such as the resident's Admissions Agreement, Physicians Report, and Service Plan.

LPA reviewed the facility's emergency and disaster plan. Riverside County Fire Marshal conducts fire drills monthly which meets department requirements. LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to Lewallen.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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