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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881601
Report Date: 08/19/2024
Date Signed: 08/19/2024 10:24:07 AM

Document Has Been Signed on 08/19/2024 10:24 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:NEIGHBOR CARE ASSISTED LIVING INCFACILITY NUMBER:
331881601
ADMINISTRATOR/
DIRECTOR:
ABRAMOVA, HELENAFACILITY TYPE:
740
ADDRESS:13787 INAJA STREETTELEPHONE:
(310) 294-6756
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 6CENSUS: 0DATE:
08/19/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Applicant Helena AbramovaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 8/19/24 Licensing Program Analyst's (LPA) Valerie Flores, Andrei Castillo, Abdoulaye Zerbo made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA's Flores, Zerbo, and Castillo met with Applicant Helena Abramova, who accompanied LPA's for the tour of the facility. The Applicant has submitted an application for 6 residents. On 6/17/24 the Riverside County Fire Department approved a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident. Per applicant, they do not have any live-in staff at this moment but may apply for it at a later date.

The home is a single-story structure consisting of three (3) bedrooms, two (2) bathrooms, a kitchen, formal dining room, family room, garage, and a backyard. The bedrooms were observed to have met the required bedding and furniture (i.e., bed, lighting, night stand, dresser, and area for sitting). The bathrooms had non-skid mats, and grab bars. There are plenty of extra linen (sheets, blankets, towels) that were observed to be in good repair. Two (2) fully charged fire extinguisher located in the kitchen and hallway. A locked cabinet was observed in the kitchen that stored disinfectants, knifes and other sharp objects. A locked cabinet was observed in the hallway for centrally stored medication. The dual carbon monoxide and smoke detector was in good working condition.

The hot water temperature was measured at 110.3 degrees Fahrenheit meeting within the required limits. 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 facility maintained the required two (2) day supply of perishable and a seven (7) day supply of nonperishable food items. The facility has an emergency food and water supply. There is a fully stocked first aid kit. Indoor and outdoor passageways were free of obstruction. LPA's observed an outdoor patio with a shaded seating area available for all resident use. There are no bodies of water observed on the premises. Per Applicant Helena, there are no firearms or ammunition on the premises.

LPA's observed the required postings of the emergency disaster plan, personal rights, employee rights, PUB475 CCLD Complaint poster, Administrator Certification and the Long term Care Ombudsman poster.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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: NEIGHBOR CARE ASSISTED LIVING INC
FACILITY NUMBER: 331881601
VISIT DATE: 08/19/2024
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During today's visit, LPA's Flores, Castillo, and Zerbo did not observe any issues or concerns. Final approval of licensure will be determined by Centralized Application Bureau (CAB).
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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