331881329-7-14-2022-18-AS-TDAN-CGBRGL-20220714130052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881329
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:00:58 PM

Document Has Been Signed on 07/14/2022 01:00 PM - 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:	FOUNTAINS AT THE CARLOTTA, THE		FACILITY NUMBER:	331881329
ADMINISTRATOR:	ELLENICH, RONALD		FACILITY TYPE:	741
ADDRESS:	41-505 CARLOTTA DRIVE		TELEPHONE:	(949) 234-3000
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92211
CAPACITY:	250	CENSUS: 185	DATE:	07/14/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Ronald Ellenich, Executive Director		TIME COMPLETED:	01:15 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 Analyst (LPA) Tricia Danielson conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. LPA met with Executive Director (ED) Ronald Ellenich. An initial application to operate a Residential Care For the Elderly (RCFE) facility was received by the Central Applications Unit (CAU) on 3/9/2022 for a total capacity of 250 non-ambulatory residents, 10 of which may be bedridden. Fire Clearance was granted on 4/11/2022 for 250 non-ambulatory residents, 10 of which may be bedridden. An annual inspection was conducted at the facility on June 2, 2022 with no deficiencies cited and no concerns were noted. The following was observed during today's visit: Structure: Facility was a two story building with adjacent casitas housing independent residents, assisted living residents, dementia residents, and a skilled nursing unit which is not licensed by the Department. Heating/Cooling System: Central heating and air conditioning system installed with control panels located in various areas of the facility. The air temperature throughout the facility was noted to be comfortable. Bedrooms: Each resident bedroom will accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, appropriate linens, adequate lighting, and were decorated with resident's personal belongings. Bathrooms: Resident bathrooms are equipped with working toilets, wash basins, and showers with non-skid materials and grab bars. Hot water checks are conducted daily. Kitchen: There was adequate room for food storage. LPA observed the stove to be operational and kitchen staff were actively preparing for the next meal. Sufficient storage for perishable food was observed and being utilized during LPA's visit. There was adequate seating for meals for all residents. Knives/sharp instruments were not observed to be accessible to any resident. (CONTINUED ON LIC 812C)

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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: FOUNTAINS AT THE CARLOTTA, THE	FACILITY NUMBER: 331881329
	VISIT DATE: 07/14/2022

NARRATIVE

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(CONTINUED FROM LIC 812)
Living room space:
There were various adequate living room/group areas with safe and adequate seating for a number of residents to utilized at any given time. There was a movie theater type area available for residents as well. LPA observed a staff led game being held in one group area. There is also two libraries and a fitness center available for resident use.
Yards/Outside:
There are various outdoor areas available with seating. A putting green and pool/spa area are availble for resident use as well. There are two pools and spa which are secured with adequate fencing. All walkways were observed to be free of obstructions.
Emergency Phone Numbers, and Exit Plan:
Let-Us-No poster, emergency phone numbers, emergency exit plan, resident Personal Rights, and facility visitation policy were posted as required in several areas of the facility.
General items:
Numerous fire extinguishers were located throughout the facility along with emergency lighting. The main fire control panel indicated all smoke alarms were operational. Resident records are stored in locked offices and/or locked cabinets. First Aid kit with required components was inspected in the Health and Wellness Director's office. Locked medication carts are utilized and outstationed for quick use for medication distribution.

Component III was previously completed on May 5, 2015 and is therefore waived for today's visit.
Pre-licensing is complete and this facility has no deficiencies.
Licensure will be granted based on final approved from CAU. An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC809 (FAS) - (06/04)

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