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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881016
Report Date: 01/13/2021
Date Signed: 01/13/2021 04:34:08 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 MS29-26
RIVERSIDE, CA 92507
FACILITY NAME:INFINITE LOVE & CARE HOMESFACILITY NUMBER:
331881016
ADMINISTRATOR:RAMOS, ERIKAFACILITY TYPE:
740
ADDRESS:37-859 KENNET ST.TELEPHONE:
(760) 625-9936
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 0DATE:
01/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Erika RamosTIME COMPLETED:
03:30 PM
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On 1/13/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced pre-licensing video conference inspection to the facility due to COVID-19. LPA met with licensee Erika Ramos. The application is for a six (6) bed, Residential Care Facility for the Elderly (RCFE) for five (5) non-ambulatory residents and 1 bedridden resident.

All bedrooms are furnished with a bed, night stand, dresser and chair. Bedrooms have adequate lighting for residents’ use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The water temperature appeared to be within range. The smoke and carbon monoxide alarms were tested and are in operating order. LPA observed fire doors to be properly functioning. Fire extinguishers are present in the facility and fully charged. The kitchen was observed to have dishes, silverware, pots, and pans. Knives/sharps are locked in kitchen drawer. Staff and resident files will be locked in a cabinet located in the office area. The medications will be locked in medicine cabinet located in the kitchen. A complete first aid kit was observed and to be complete. The chemicals will be locked and kept inaccessible to residents. The backyard was observed to be fully fenced with an unlocked gate and table/chairs for the residents' comfort while sitting outside. No bodies of water were on the premises. The phone number designated for the facility is (760) 834-8081. There is an emergency exit, free of obstruction. The fire inspection was conducted and approved.

The facility was evaluated in accordance with California Code of Regulations (CCR) Title 22. The facility appears to be ready for licensure.

An exit interview was conducted, and a copy of this report was reviewed and provided to Erika Ramos via email to obtain signature.
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte HenryTELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2021
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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