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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530122
Report Date: 01/03/2024
Date Signed: 01/03/2024 11:38:46 AM


Document Has Been Signed on 01/03/2024 11:38 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:TRUECARE SENIOR HOMEFACILITY NUMBER:
335530122
ADMINISTRATOR:KAUR, PARMINDERFACILITY TYPE:
740
ADDRESS:13761 RIVER DOWNS STTELEPHONE:
(714) 388-8831
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 0DATE:
01/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Parminder Kaur & Rajnish DhunnaTIME COMPLETED:
11:40 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the True Care Senior Home property announced to conduct a Prelicensing Inspection Visit. LPA was greeted by Administrator, Parminder Kaur and Staff Members, Rajnish Dhunna and Denise Molde. LPA introduced self and stated purpose of the visit. LPA was invited inside and provided a space to work. Administrator and staff members then provided LPA with tour of the property; LPA observed the following:

Application: This is an initial application for operation of a Residential Care Facility for the Elderly, (RCFE). Fire Inspection took place on 11/1/23. Fire Clearance granted for one, (1) ambulatory resident, Four, (4) non-ambulatory and 1 bedridden resident.

Buildings and Grounds: The residence is composed of two, (2) levels; six, (6) bedrooms, three (3) bathrooms, 2 living room areas, kitchen, dining room, laundry room, an attached garage and backyard. Interior pathways were free of clutter and obstructions. Smoke, Fire and Carbon Monoxide alarms were tested and found operational. Fire Extinguishers, (3) were observed to be fully charged. All fire extinguishers last inspected September 2023. The backyard included accessibility, adequate spacing for activities and shaded seating. Adequate for capacity. Exterior pathways were clear and unobstructed. There are no pools or other bodies of water located on the property. Administrator and Licensee report there are no firearms, weapons or ammunition kept in the facility.

Resident Rooms - each room included regulated mattress, bed linens, storage space, seating, intact window screens and sufficient lighting. Additional linens are maintained in a central hallway cabinet; accessible to those who may need them. The master bedroom included an attached jack and jill styled bathroom. This bathroom includes built-in seating and a number of handrails and non-slip grip materials to aid in fall prevention. Bathroom appliances were in working condition. Each contained adequate amounts of hand hygiene and paper supplies.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: TRUECARE SENIOR HOME
FACILITY NUMBER: 335530122
VISIT DATE: 01/03/2024
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Kitchen & Food Service: LPA measured the water temperature in the kitchen between 110 - 122 degrees Fahrenheit. Administrator pointed out two cabinets and a drawer included locking mechanisms; revealing these to be the designated space for facility and resident files. Also, sharp objects. LPA observed adquate amounts of utensils and dishware properly stored for the requested capacity. Kitchen appliances were in good condition and working order. The facility food menu will be posted in a prominent place near the kitchen for review.

Living Rooms- Each space included adequate seating for residents, guests and visitors. Activity supplies such as board games, connect four, and televisions were also observed available for resident use. The facility maintains an internet connection and working landline phone for its residents. Functional washer and dryer were observed en route to the attached garage in the laundry room. The laundry room also included a securable cabinet for cleaning supplies and tools to be housed.

Storage and Supplies: Administrator showed LPA the secure staff office; where medications will be stored inaccessible to residents. Emergency/disaster supplies and food, 1st aid kits were observed in secure a closet underneath the stairs.

The property's second level was secured by a gate restricting access to unauthorized individuals. Administrator expressed that the second level is restricted to staff only. The second floor includes a restroom, bedroom and loft style den. Bedroom securable.

Forms: The following forms were observed posted in prominent places: Resident Rights, Resident Council, If you see something say something, Personal Rights, Long Term Care Ombudsman, Infection Control, Facility Sketch/Evacuation Plans in each room. Labor laws and licensing information.

No concerns were observed during the inspection. LPA and staff completed the COMP.III Orientation during visit. LPA will inform the Centralized Applications Bureau the home is ready to be licensed. An exit interview was conducted. This report was reviewed, discussed then provided to Parminder Kaur.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024
LIC809 (FAS) - (06/04)
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