331881211-10-14-2024-18-AS-VMIN-DA2Q33-20241014114803

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881211
Report Date: 10/14/2024
Date Signed: 10/14/2024 11:48:15 AM

Document Has Been Signed on 10/14/2024 11:48 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:	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: 3	DATE:	10/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	ADMINISTRATOR, CHARMAINE WILLIAMS.		TIME COMPLETED:	11:55 AM

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	On October 14, 2024, Licensing Program Analyst (LPA), Venus Mixson, made an unannounced visit to the facility for the purpose of conducting the Required Annual inspection, and met with Charmaine Williams, Administrator. LPA introduced herself and stated the purpose for the visit. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on cite. PHYSICAL PLANT: Facility is located at 1989 Warwick Street, San Jacinto, CA. 92582, and the land line phone number is (951) 654-7367 and is operable. Facility is licensed for six Elderly Adults for a (740) facility type and is operating at three elderly adults which is within the conditions and limitations of the license. Outdoor and indoor: Passageways are free of obstruction and debris at the time of this visit. There were no pools or bodies of water observed on the property at this time, and Administrator stated there are no known weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to residents in care. The facility temperature was within in regulations for this time of day and the season, and there was sufficient lighting throughout the facility. Hot Water temperature: was tested and found to be within regulations. LPA Mixson observed the Fire extinguisher located in the kitchen and has proper inspection tag. Inspection by Hedrick Fire Protection is scheduled for 10/18/2024. The smoke and carbon monoxide alarms were in the green. The interior and exterior areas of the home were observed to be clean and organized. FOOD SERVICE: There was a variety of food types which were sealed and stored in a safe and healthful manner. Food supply of nonperishable and perishable food items were sufficient for the number of residents in care. The kitchen was observed to be clean, neat, and orderly. Additionally, kitchen was free of orders and any signs of pest. LPA observed the required two-day supply of perishable and seven-day supply of non-perishable food items.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

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: 10/14/2024

NARRATIVE

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Care & Supervision/Administration: Adequate staff are present for the supervision of resident in care. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed administrator possesses a current administrator’s certificate with an expiration date of 05/24/2025.

Records Reviewed and Resident/Staff Files: LPA reviewed staff and resident files and reviewed the facility's staff schedule. The staff files reviewed had criminal clearance and updated training along with First Aid Certification. The residents’ files reviewed possessed required paperwork. Including LIC 602, Physician's Report, LIC 604A, Admissions Agreement, and LIC 601, Emergency Information.

MEDICATION: Medications were reviewed for residents in care, and medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to residents in care. Medications and medication documentation was observed to be organized, monitored, and free of discrepancies at this time.

Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards, and was conducted in February of 2024.

Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures.

There were no deficiencies observed or cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview was conducted where a copy of this report was discussed and given to Administrator, Charmaine Williams.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024

LIC809 (FAS) - (06/04)

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