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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881236
Report Date: 12/10/2024
Date Signed: 12/10/2024 11:24:47 AM

Document Has Been Signed on 12/10/2024 11:24 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PARKER'S PALACE RESIDENTIALFACILITY NUMBER:
331881236
ADMINISTRATOR/
DIRECTOR:		PARKER, GREGORYFACILITY TYPE:
735
ADDRESS:21790 CALLE MONACOTELEPHONE:
(951) 212-9218
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 4CENSUS: 3DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Rachelle Parker-AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to conduct the required annual inspection. LPA was greeted at the door by Caregiver, Ocsheana Farris and explained the purpose of the visit. Administrators, Rachelle Parker and Amarilys Vainez arrived shortly. At the time of the visit, the three (3) clients were present. A tour of the facility was conducted inside and out. The facility is approved for four (4) Ambulatory of which three (3) may be Non-Ambulatory.
The facility is a one story 4 bedroom 2 bathroom home. LPA observed clients bedroom furnishings to be in good repair with adequate lighting. Furniture throughout the house was observed to be in good condition. Clients have clean linen in good repair and sufficient hygiene products to meet their needs. All required postings are placed in a prominent area; facility sketch, personal rights, and emergency phone numbers were found posted in the facility. Facility has multiple operating dual smoke alarms and carbon monoxide detector that meet statutory standards. Fire extinguishers were examined and determined to be in compliance. Facility has one (1) Fire Extinguisher mounted on the dining area of the facility. All inside and outside passageways are clear of obstructions. There are no pools or bodies of water observed. According to Administrator, no guns and/or ammunition are stored on the premises.
LPA observed the kitchen area to be clean and odor free with sufficient dishes and glassware. A two day supply of perishable, and a seven day supply of non-perishable, food items were observed. Knives and sharp objects were locked in a kitchen cabinet. There is a locked cabinet where the Client files and Medications are stored located in the hallway next to the laundry room. Chemicals and poisons are stored in a locked cabinet in the garage. LPA observed a hallway cabinet filled with clean towels, blankets, and linen, available for the clients. LPA reviewed the Medication Administration Record along with the physical medications for three (3) clients and did not discover any discrepancies. LPA reviewed three (3) client files and observed clients had Signed admission agreements, and all necessary documents in clients files. LPA reviewed the facility's Fire and Training Earthquake Logs and the facility's last fire drill was conducted was on 12/1/24 and earthquake drill on 12/1/24. Facility conducts the fire and earthquake drills on a monthly basis.

(Continue on LIC809C)

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PARKER'S PALACE RESIDENTIAL
FACILITY NUMBER: 331881236
VISIT DATE: 12/10/2024
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LPA reviewed the Record of Client's/Resident's Safeguarded Cash Resources (LIC 405) and Administrator Amarilys Vainez reviewed the physical monies for one (1) client, and no discrepancies were discovered.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
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