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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881153
Report Date: 06/13/2022
Date Signed: 06/13/2022 11:49:56 AM

Document Has Been Signed on 06/13/2022 11:49 AM - It Cannot Be Edited

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:WESTWARD RESIDENTIAL CAREFACILITY NUMBER:
331881153
ADMINISTRATOR:YBANEZ, ROSYFACILITY TYPE:
735
ADDRESS:156 FOX TROTTER PLACETELEPHONE:
(951) 665-3767
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY: 4CENSUS: 3DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Rosy Ybanez, AdministratorTIME COMPLETED:
11:55 AM
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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 Rosy Ybanez, Administrator and explained the purpose of the visit. At the time of visit there was 1 staff and 1 resident 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 did not observed any Covid-19 postings posted upon entry or throughout the facility. The facility does have the postings, and thought that they did not have to posted. Technical advisory provided. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer).

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks, however they are not documented. Technical advisory provided. The facility will contact the resident's physician should there be event of any COVID-19 related illnesses.

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 Rosy Ybanez, Administrator
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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