331881372-7-30-2024-18-AS-SJEN-D7NT9W-20240730143236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881372
Report Date: 07/30/2024
Date Signed: 07/30/2024 02:34:13 PM

Document Has Been Signed on 07/30/2024 02:34 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:	SEGOVIA OF PALM DESERT		FACILITY NUMBER:	331881372
ADMINISTRATOR:	SALVADOR JIMENEZ		FACILITY TYPE:	741
ADDRESS:	39905 VIA SCENA		TELEPHONE:	(760) 674-3200
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	182	CENSUS: 138	DATE:	07/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Salvador Jimenez, administrator		TIME COMPLETED:	02:35 PM

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Licensing Program Analyst (LPA), Seo Jeon, made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with administrator, Salvador Jimenez and assistant executive director, Alishia Perez and they were notified of the purpose for the visit.

This facility is 2 story building with 121 apartment units including 4 casitas. This facility currently has 138 residents including 3 hospice and 1 bedridden. This facility has maintenance staffs who are in charge of regular cleaning and maintenance. LPA reviewed the facility's infection control plan and found all required infection control measures.

LPA observed 2 full service restaurants, movie theater, game room, art room, gym and several lounges. Physical plant, floors, windows, and doors were observed to be clean and in good repair. Fixtures and furniture were in good repair and were present. The outdoor area was observed to have lots of shaded area for clients and was free of hazards. This facility has fenced/gated swimming pool, several gazebos and putting green. Cleaning chemicals are all handled by the maintenance staffs. LPA was informed that management, maintenance staff and residents are in constant communication for any maintenance issues. The hot water temperature was recorded from 108.8 and 109.9 in one of the client bathrooms and lounge room on 2nd floor.

All units are apartments for independent living with kitchen, bathroom and bedrooms. Residents can either dine at the restaurants or receive food services from the facility.

Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff schedule showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo Jeon	TELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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: SEGOVIA OF PALM DESERT	FACILITY NUMBER: 331881372
	VISIT DATE: 07/30/2024

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LPA reviewed eight(8) staff files and training logs. All staffs have criminal clearance and updated training along with CPR/First Aid Certification. Nine(9) client files were reviewed and possessed all required paperwork.

Medications are stored in a locked cabinet inside a med room with locked door on the first floor. Computerized medication log is maintained. Medications logs were reviewed and they appear to have been dispensed accurately.

LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility performs monthly fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. Smoke and carbon monoxide alarms were tested and observed to be in working condition. Fire extinguishers are all inspected on monthly basis and tags show the same.

No deficiencies were 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 provided to administrator, Salvador Jimenez.

LPA left the facility at 12:20pm and returned at 1:20pm.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Seo Jeon	TELEPHONE: 951-248-0309
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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