331880812-1-24-2024-18-AS-JARA-CZSR3Y-20240124114043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880812
Report Date: 01/24/2024
Date Signed: 01/24/2024 11:41:00 AM

Document Has Been Signed on 01/24/2024 11:41 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:	RIVERWALK VISTA SENIOR CARE LLC		FACILITY NUMBER:	331880812
ADMINISTRATOR:	VALENZUELA, MYRNA D		FACILITY TYPE:	740
ADDRESS:	10831 PORTOFINO LANE		TELEPHONE:	(951) 729-6243
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92503
CAPACITY:	6	CENSUS: 6	DATE:	01/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Administrator, Ana Marie Huerto		TIME COMPLETED:	11:50 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 Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Administrator, Ana Marie Huerto who was informed of the purpose of the visit. At time of visit there were (6) clients and (3) staff present. The facility is a one story home with (5) bedrooms and (2) bathrooms with attached garage. The facility does not have a pool or fire arms. The facility is a residential care facility for the elderly serving elderly ages 60 and above. LPA was informed that the facility has been sold and transferred to new ownership. Based on interview it was found that the licensing agency was not notified and residents were not given written notice. LPA found through interview that the facility has not yet submitted an application to the licensing agency for change of ownership. Deficiencies were discussed and cited for these issues and plans of correction were created with the new owner and administrator, Ana Marie Huerto. Infection Control: LPA observed hand hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. Technical note was issued for staff to have a infection control plan at the facility for licensing review. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were present and in good repair. The facility's outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The carbon monoxide detector was tested and operational during the visit. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required food items.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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: RIVERWALK VISTA SENIOR CARE LLC	FACILITY NUMBER: 331880812
	VISIT DATE: 01/24/2024

NARRATIVE

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Record Review and Resident/Staff Files: LPA reviewed staff files and training along with CPR/First Aid. Client files were reviewed and possessed the required paperwork.

Health Related Services/ Incidental Medical Services: All client medication was locked in hallway cabinet. LPA reviewed client medications and found that MARS and medication was accounted for.

Disaster preparedness: Technical note was issued for emergency plan to be at facility for licensing review. LPA reviewed documentation showing last fire drill conducted on 10/16/2023. Technical note was issued for facility to conduct a drill by the end of the month.

The need for an informal meeting was discussed with the administrator during the time of the visit. Contact will be made in order to accord a date for the meeting and a letter will be sent to the Licensee and Administrator.

An exit interview was conducted where a copy of this report, along with appeal rights and deficiencies pages were reviewed and provided to Administrator, Ana Marie Huerto

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/24/2024 11:41 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: RIVERWALK VISTA SENIOR CARE LLC	FACILITY NUMBER: 331880812
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.191(b)(2)

(b) Except as provided in subdivision (e)…(2)The prospective buyer shall submit an application for a license…within five days of the acceptance of the offer by the seller. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above by not submitting an application whitin the required timeframe which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/08/2024
	Plan of Correction
1 2 3 4	The administrator agreed to send an application to CAB and send the LPA proof of packet and check sent for application of change in ownership by the POC due date.

Type B

Section Cited

CCR

87109(b)

(b) The licensee shall notify the licensing agency and all residents receiving services, or their representatives, in writing...in all cases at least thirty (30) days prior to the transfer of the property or business, or at the time that a bona fide offer is made, whichever period is longer... This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above with not providing the residents or licensing agency of transfer of the facility, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/08/2024
	Plan of Correction
1 2 3 4	The administrator agreed to send a written notification to all residents which were residing in the home at the time of the sale. The administrtor stated these R1, R2 and R3. They also agreed to send the LPA a written notice with deatils on the transfer of the business by POC due date.

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 Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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