331881211-10-14-2021-18-AS-STOS-C7RV6C-20211013160919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881211
Report Date: 10/13/2021
Date Signed: 10/14/2021 11:02:16 AM

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:	ENDLESS CARE FACILITY		FACILITY NUMBER:	331881211
ADMINISTRATOR:	LUNKAD, RUSHABH		FACILITY TYPE:	740
ADDRESS:	1989 WARWICK STREET		TELEPHONE:	(562) 341-1417
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92582
CAPACITY:	6	CENSUS: 6	DATE:	10/13/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Rushabh Lunkad, Applicant		TIME COMPLETED:	04:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs), Stephanie Torres and David Cuevas, conducted an announced pre-licensing inspection to the facility. The LPA met with Licensee, Rushabh Lunkad. There are currently six (6) residents in care. Application: The application is for a Residential Care Facility for the Elderly. The fire clearance has been granted for six (6) non-ambulatory residents. Buildings and Grounds: The home is composed of four (4) resident bedrooms, one staff bedroom, three (3) bathrooms, a garage (with laundry), a living room, kitchen and dinning area, and front/back yard areas. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There are no pools or other bodies of water located at the home. According to Lunkad, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip flooring available. The hot water was tested and measured at 117.6 degrees Fahrenheit, which is within regulatory limits. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Storage and Supplies: Activities were observed to be available. Medications will be stored inaccessible to any unauthorized individuals. Secured areas are available for facility files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away under the kitchen sick, inaccessible. Linens, and equipment are all in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ENDLESS CARE FACILITY	FACILITY NUMBER: 331881211
	VISIT DATE: 10/13/2021

NARRATIVE

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are in working order. Sharps will be stored in a locked kitchen cabinet, available only to authorized individuals.

Forms: The following signs were observed to be posted at the home: Theft and Loss Policies, Personal Rights, and Facility Sketch (LIC 999), Labor Law Information, and Complaint Information.

No corrections were observed to be needed at this time. The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensure. This report was discussed with and a copy provided to Lunkad via email.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC809 (FAS) - (06/04)

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