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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880858
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:30:35 PM

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
RIVERSIDE, CA 92507
FACILITY NAME:ALONDRA RESIDENTIAL CARE FACILITYFACILITY NUMBER:
331880858
ADMINISTRATOR:TUMALIUAN, MARIA DIANAFACILITY TYPE:
740
ADDRESS:40534 ALONDRA DRIVETELEPHONE:
(951) 416-4717
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 5DATE:
11/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Benjamin Villanueva, CaregiverTIME COMPLETED:
02:40 PM
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Prior to LPAs visit LPA conducted the Covid-19 risk assessment. Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Caregiver Benjamin Villanueva. At the time of visit there were 2 staff and 5 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer), as well as an ample supply of EPA approved disinfects and cleaners.

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks two times a day. The facility will contact the resident's physician and responsible party should there be event of any COVID-19 related illnesses. Per the facility's mitigation plan submitted on 7/12/21, the infection control lead conducts a weekly inventory of PPE supply as well as updates staff and residents on recommendations from the CDC as well as the department. Each staff is responsible for cleaning and disinfecting the highly touched surfaces, three times a day.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to Caregiver Benjamin Villanueva.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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