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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881403
Report Date: 09/04/2024
Date Signed: 09/05/2024 08:51:12 AM

Document Has Been Signed on 09/05/2024 08:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:AXIS DESERT HOT SPRINGS - CFACILITY NUMBER:
331881403
ADMINISTRATOR/
DIRECTOR:		STONE, YEVETTEFACILITY TYPE:
772
ADDRESS:66563 5TH STREET, BUILDING CTELEPHONE:
(339) 293-9066
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 6CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Adminstrator Yvette StoneTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On 9/4/24 Licensing Program Analyst's (LPA) Abdoulaye Zerbo and Valerie Flores made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA's Flores and Zerbo met with Administrator Yvette Stone, 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 are offering a 24-hour staff schedule.

The facility is a single-story structure consisting of three (3) resident bedrooms, four (4) bathrooms, therapist office, staff office, formal dining room, family room, and courtyard. The bedrooms were equipped with the required bedding and furniture (i.e., bed, lighting, nightstand, dresser, and area for seating). 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 C. A locked cabinet was observed in the staff office for centrally stored medication. The dual carbon monoxide and smoke detector was in good working condition. During the visit, LPA's did not observe a designated kitchen area to meet the regulations for food services. After reviewing the Plan of Operation submitted to the department, there is not an outlined plan on how the facility is going to meet the food service requirements. The applicant applied for two additional licenses’ for facilities (Axis Building A and Axis Building B) that reside on the same lot to which both maintain kitchens. It is recommended that the Applicant outline on the Plan of Operation that food services are to be provided by building A and/or B.

The water temperature was measured at 118.1 degrees Fahrenheit meeting within the required limits. The facility has an emergency disaster plan and approved infection control training plan on file. There is a fully stocked first aid kit. Indoor and outdoor passageways were free of obstruction. LPA's observed a refrigerator in the family room with a temperature that measured at 39 degrees Fahrenheit meeting within the required limit. There are no bodies of water observed on the premises.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
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 - C
FACILITY NUMBER: 331881403
VISIT DATE: 09/04/2024
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Per Administrator Yvette Patterson ( Licensed Marriage Family Therapist) (LMFT), 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.



Based on today's inspection it is recommended that the facility be licensed once the following is completed:

Applicant submit an updated Plan of Operation on how food services will be met to all residents in care for Building C.

Applicant completed COMP III on 8/20/24. An exit interview was conducted and a copy of this report was provided to Administrator Yvette.

LPA's were off-site from 1:00PM - 2:00PM.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
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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