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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880815
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:41:52 AM


Document Has Been Signed on 01/13/2023 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:A TENDER TOUCH SENIOR LIVING LLCFACILITY NUMBER:
331880815
ADMINISTRATOR:MOJICA, FLORENCE AFACILITY TYPE:
740
ADDRESS:1651 ROSE AVENUETELEPHONE:
(310) 592-5338
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:6CENSUS: 6DATE:
01/13/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Teresita Espinoza -Manager TIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced Health & Safety check at this facility. Upon arrival LPA met with Dawn Hebert and she was informed of the purpose of the visit. During LPA visit the manager Teresita Espinoza arrived and she was also informed of the purpose of the visit.

The Health and Safety check included an overall observation of the facility inside, and outside including food supply, physical plant, clients in care, and staffing.

The tour of the facility included residents’ bedrooms, bathrooms, and kitchen. LPA Allen observed a 7-day supply of non-perishable and 3-days of perishable food supply.

Dawn confirmed that there are 6 clients at the facility. LPA observed five (5) clients during the visit there were two (2) clients in the TV room and the other three (3) clients were in their bedrooms. Dawn said that one client was at a doctors appointment.

During the visit LPA observed and interviewed support staff and there was one staff member (S1) that was not cleared or associated to work at the facility.

There was one deficiency cited during today's visit

An exit interview was conducted where this report LIC809 ,LIC 809-D and LIC421BG was discussed and provided to Teresita Espinoza at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
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


Document Has Been Signed on 01/13/2023 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507


FACILITY NAME: A TENDER TOUCH SENIOR LIVING LLC
FACILITY NUMBER: 331880815

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2023
Section Cited

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87355. Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record..This requirement is not met as evidenced by:
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The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 12/14/2023
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Based on observation, interview, and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for one (1) day without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.
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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: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2