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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880889
Report Date: 06/08/2021
Date Signed: 06/08/2021 01:36:31 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:ELDERLY BETTER HOMEFACILITY NUMBER:
331880889
ADMINISTRATOR:ALSAYEH, HALAFACILITY TYPE:
740
ADDRESS:20461 MYRON STTELEPHONE:
(951) 349-3440
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:2CENSUS: 0DATE:
06/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Hala AlsayehTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Williams arrived and was granted entry by Administrator, Hala Alsayeh. Alsayeh confirmed that there are currently no cases or exposures of COVID-19 within the facility. Alsayeh confirmed that the facility has no residents and is currently not operational.

During the inspection, LPA Williams conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. LPA Williams observed that the facility was equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a 30+ day supply of Personal Protective Equipment (PPE). The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. LPA advised the Administrator to set-up a screening station for visitors where they may sign-in and be screened for COVID-19 symptoms. LPA observed no COVID-19 postings throughout the facility; LPA advised Administrator to post appropriate COVID-19/hand washing postings.

LPA Williams observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted where this report was discussed and a copy of this report was also provided to Alsayeh at the conclusion of the inspection.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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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