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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881122
Report Date: 04/22/2021
Date Signed: 04/22/2021 03:29:58 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:EMERALD ROSE GARDEN INC.FACILITY NUMBER:
331881122
ADMINISTRATOR:NAVAREZ, JULIE CFACILITY TYPE:
740
ADDRESS:74560 CORAL BELLS CIRTELEPHONE:
(909) 533-0642
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 0DATE:
04/22/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Julie NavarezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Javier Prieto conducted an announced visit with facility administrator Julie Navarez for the purpose for performing a virtual pre-licensing inspection. Fire clearance is approved for six (6) non-ambulatory, one of which can be bedridden, on 03/22/2021. Facility will serve Elderly resident 59 years and above

Structure: Facility is a one story, four (4) bedroom, three (3) bathrooms with two car garage. The facility maintains a shaded area for all clients in the home. The client bedrooms can accommodate the client's furnishings.
Bathrooms: All bathrooms have a working toilet, shower and sink. Bathrooms have appropriate washing supplies and towels for client use.
Linens: Are kept in the facility hallway adjacent to all the bedrooms.
Hygiene Supplies: Are kept locked in the cabinets
Food Service: Kitchen has adequate counter and cupboard space to meet the staff and client’s needs. Stove burners, oven, microwave, washer & dryer are working. Knives are kept locked in the pantry located in the kitchen. Refrigerator in the home is stocked. .
Smoke detectors and Carbon Monoxide Units Were tested and found in working condition.
Toxins Are stored in a locked in the laundry room and as well as the garage.
Medications Are centrally stored and locked in the kitchen cabinet including the first aid kit will be kept in cabinet. Medication Administrator Records logs are locked as well
Resident & Staff Files; Are centrally stored and locked. Overall, the residence meets Title 22 requirements for licensing standards. No corrections are needed at this time. A copy of this report was provided to the administrator. LPA Prieto conducted a Component III with administrator Navarez on this day as well.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021
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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