331880889-5-26-2023-18-AS-CNWE-CS7S9Z-20230526134133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880889
Report Date: 05/26/2023
Date Signed: 05/26/2023 01:41:39 PM

Document Has Been Signed on 05/26/2023 01:41 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:	ELDERLY BETTER HOME		FACILITY NUMBER:	331880889
ADMINISTRATOR:	ALSAYEH, HALA		FACILITY TYPE:	740
ADDRESS:	20461 MYRON ST		TELEPHONE:	(951) 349-3440
CITY:	PERRIS	STATE: CA	ZIP CODE:	92570
CAPACITY:	2	CENSUS: 0	DATE:	05/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Administrator Hala Alsayeh		TIME COMPLETED:	01:50 PM

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On 5/26/2023, Licensing Program Analysts (LPAs) Chinwe Nwogene and Janette Romero arrived unannounced at the facility to conduct an annual inspection. LPAs were greeted and granted entry by Administrator, Hala Alsayeh who was informed of the purpose of visit. At the time of visit there was 0 staff and 0 residents present. LPAs toured the facility inside and out with Hala.

Tour included:

Kitchen; LPAs toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lids. Dishwasher is used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 40 degrees Fahrenheit and Freezer was measures at 0 degrees Fahrenheit.

Dining and Livingroom; LPAs toured the dinning and Livingroom area. LPAs observed area to be clean and furnitures in good condition. Temperature was 70 degrees Fahrenheit.

Hallway; LPAs toured the hallway and observed hallway to be clean with no pathway obstruction. LPAs inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPAs observed additional linens and hygiene items.

Medications; LPAs did not observe any medication because there was no resident in care. However, medications will be stored in a locked medication cabinet located in the kitchen and will be distributed according to physician orders. The first aid kit was complete.

Continue on LIC809-C.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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: ELDERLY BETTER HOME	FACILITY NUMBER: 331880889
	VISIT DATE: 05/26/2023

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Continued From LIC809.

Bathroom; LPAs observed resident bathroom and observed bathroom to be clean and equipped with grab bar. There is also a good number of personal toiletries available. The hot water measured at 105 degrees Fahrenheit.

Bedroom; LPAs toured one #1 out of #1 resident bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility.

Garage; LPAs observed garage to be clean.

Laundry; LPAs toured the laundry room and observed room to be clean. Washing machine and dryer are all in good repair and sufficient for the approved capacity. Cleaning supplies are stored away in the garage, inaccessible to clients.

Backyard; LPAs toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored.

Records: Facility currently has no staff and no client in care; therefore, no client or staff records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expired on 2/12/2023. Hala stated the Administrator recertification packet was sent to the department in February 2023 but haven’t received the new Administrator certificate.

Interview; No interview was conducted.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Hala Alsayeh.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC809 (FAS) - (06/04)

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