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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881402
Report Date: 09/04/2024
Date Signed: 09/05/2024 04:56:45 PM

Document Has Been Signed on 09/05/2024 04:56 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:AXIS DESERT HOT SPRINGS - BFACILITY NUMBER:
331881402
ADMINISTRATOR/
DIRECTOR:		FALCON, TARAFACILITY TYPE:
772
ADDRESS:66563 5TH STREET, BUILDING BTELEPHONE:
(339) 293-9066
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 6CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Adminstrator Tara FalconTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 9/4/24 Licensing Program Analyst's (LPA) Valerie Flores and Abdoulaye Zerbo made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA's Flores and Zerbo met with Administrator Tara Falcon, who accompanied LPA's for the tour of the facility. The Applicant has submitted an application for six (6) residents. On 6/15/23 the Riverside County Fire Department approved a fire clearance for six (6) ambulatory residents. Per applicant, they do not have any live-in staff and do not wish to have any in the future.

The facility is a single-story structure consisting of three (3) resident bedrooms, five (5) bathrooms, a kitchen, living room, dining area, and staff office. The bedrooms were observed to have met the required bedding and furniture (i.e., bed, lighting, nightstand, dresser, and area for sitting). There are plenty of extra linen (sheets, blankets, towels) that were observed to be in good repair. Two (2) fully charged fire extinguisher located on the exterior of Building B. A locked cabinet was observed in the staff room for centrally stored medication, knives and other sharp objects. The dual carbon monoxide and smoke detector was in good working condition. LPA's observed a sufficient amount of games and activities in the living room to encourage client interaction.

The facility has an emergency disaster plan and approved infection control training plan on file. The facility has a sufficient supply of dishes, cooking and eating utensils, that were observed to be in good repair. The refrigerator temperature measured at 30 degrees Fahrenheit meeting within the required limits. There is a fully stocked first aid kit. Indoor and outdoor passageways were free of obstruction. There are no bodies of water located on the premises. Per Administrator Tara, there are no firearms or ammunition on the premises.

LPA's observed the required postings of the emergency disaster plan, personal rights, employee rights, and PUB475 CCLD Complaint poster located in Unit 3.



Continuation on LIC809C...
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: AXIS DESERT HOT SPRINGS - B
FACILITY NUMBER: 331881402
VISIT DATE: 09/04/2024
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During today's visit, LPA's Flores and Zerbo did not observe any issues or concerns. Applicant completed COMP III in August of 2024. Final approval of licensure will be determined by Centralized Application Bureau (CAB). A exit interview and a copy of this report was given to Administrator Tara.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
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