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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881345
Report Date: 10/20/2023
Date Signed: 10/20/2023 03:34:59 PM

Document Has Been Signed on 10/20/2023 03:34 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SOLAIRE AT ORANGE GROVE HOMES INCFACILITY NUMBER:
331881345
ADMINISTRATOR:JIMENA, MARLITAFACILITY TYPE:
735
ADDRESS:5802 ORANGE GROVE AVETELEPHONE:
(562) 569-8115
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 4CENSUS: 0DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Christian Almendares, LicenseeTIME COMPLETED:
03:40 PM
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On 10/20/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Licensee, Christian Almendares who was informed of the purpose of visit. At the time of visit there was 0 staff and 0 residents present. LPA was informed facility is in the process of being vendorized by IRC. LPA toured the facility inside and out with Christian Almendares.

Tour included:

Kitchen; LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lids. Fridge, Freezer and all need appliances were present and shown to be in working condition and clean.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 72 degrees Fahrenheit.



Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medication; Medications will be stored in separate bins inside of a locked medication cabinet and will distributed according to physician orders. The first aid kit was complete.



Bathroom; LPA toured two #2 out of #2 residents bathrooms and observed bathrooms to be clean and equipped with non-slip mat. There is also a good number of personal toiletries available. The hot water measured at 105 degrees Fahrenheit.

Continue on LIC809-C
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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: SOLAIRE AT ORANGE GROVE HOMES INC
FACILITY NUMBER: 331881345
VISIT DATE: 10/20/2023
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Continued from LIC809.

Bedroom; LPA toured four #4 out of #4 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Resident #1 bedroom has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 105 degrees Fahrenheit.

Laundry; Washing machine and dryer are all in good repair and sufficient for the approved capacity.

Garage; LPA tour the garage and observed garage to be clean. Cleaning supplies are stored away in the garage and will be inaccessible to clients.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. No bodies of water were observed.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored.

Records: All required postings were posted near the entryway and throughout the facility. The administrator certificate expired on 7/18/2023. Christian stated the administrator renewal packet was sent to the department but haven't received the administrator certificate yet.

Interview; No interview was conducted.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Christian Almendares.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC809 (FAS) - (06/04)
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