331881296-3-11-2022-18-AS-VMIN-CCEQ6W-20220311105413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881296
Report Date: 03/11/2022
Date Signed: 03/11/2022 10:54:30 AM

Document Has Been Signed on 03/11/2022 10:54 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:	ST. REGINALD SENIOR CARE HOME, INC.		FACILITY NUMBER:	331881296
ADMINISTRATOR:	ROSENBURG, KURT I.		FACILITY TYPE:	740
ADDRESS:	68655 SAN FELIPE RD		TELEPHONE:	(760) 699-7017
CITY:	CATHEDRAL CITY	STATE: CA	ZIP CODE:	92234
CAPACITY:	6	CENSUS: 4	DATE:	03/11/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	KURT ROSENBURG		TIME COMPLETED:	11:00 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 3/11/2022 Licensing Program Analysts (LPAs)Crystal Colvin and Venus Mixson conducted a scheduled visit for the purpose of conducting a pre-licensing inspection. LPAs met with administrator Kurt Rosenberg and was shown the facility inside and outside. Facility is a single-story house with (6) resident bedrooms, (6) bathrooms, a living room, a small office area, kitchen, a garage and a backyard. On 12/30/2021, the City of Cathedral City Fire Department approved the facility for 5 Non- ambulatory residents and 1 bedridden. During today's inspection, LPA's toured the interior and exterior of the facility. The medications were centrally stored and locked inside a medication closet. The facility is equipped with lights in the passages. The facility is also stocked with emergency night lights throughout the facility. The smoke and carbon monoxide detectors were tested and are operable. There was one fire extinguisher observed. All cleaning supplies are locked in a cabinet located in the garage. The sharp objects are locked in a kitchen drawer. All doors, and passageways are clear from obstruction. There were no pools or bodies of water on the premises. All beds have the required linen and supplies. There was enough clean linen and hygiene items. There was appropriate lighting in each

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0231
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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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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: ST. REGINALD SENIOR CARE HOME, INC.	FACILITY NUMBER: 331881296
	VISIT DATE: 03/11/2022

NARRATIVE

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room a table/desk, night stand, bed and a chair.
The hot water tested and ranged from 117.9 degrees F. All kitchen appliances operate properly. The bathrooms are equipped with grab bars and non-skid floor mats and/or surfaces. All garbage cans have tight fitting lids. The facility is stocked with a 2- day supply of perishables and a 7- day supply of non-perishable food items. The facility was stocked with dishes, tableware, and utensils in good repair and enough for the capacity. The resident and staff files were locked in a drawer. LPA's observed the emergency disaster plan, facility sketch, personal rights, and complaint procedures that are hung on the wall towards the right, by the front door. There was adequate seating in the common areas. There were two or three stocked first aid kit with manual. The facility had activities to provide entertainment and encourage socialization for the residents.
Composition III orientation was completed after the inspection.

The facility had a working telephone.

An exit interview was conducted, and a copy of this report was left with the Administrator Kurt Rosenberg.

There were no deficiencies observed during this visit facility.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0231
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC809 (FAS) - (06/04)

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