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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530134
Report Date: 01/16/2025
Date Signed: 01/16/2025 01:25:05 PM

Document Has Been Signed on 01/16/2025 01:25 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
335530134
ADMINISTRATOR/
DIRECTOR:		GARCIA, GRISELDA "GRACIE".FACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVENUETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 98CENSUS: 78DATE:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Facility Administrator-Griselda GarciaTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Beena Singh conducted an announced pre-licensing visit to the facility. LPA met with Facility Director Griselda Garcia.

Licensing Program Analysts (LPA) Beena Singh conducted an announced pre-licensing visit to the facility. The purpose of the visit was to conduct a required comprehensive pre-licensing inspection for Change of ownership (CHOW)LPA met with Facility Administrator Facility Administrator Griselda Garcia.

Facility Administrator/Director-Griselda Garcia accompanied LPA Singh on a tour of the inside and outside of the facility The facility is a fifty (50) bedroom, fifty (50) bathroom home with a kitchen/dining area, living room/activity room. The facility is a Residential Care Facility for the Elderly (RCFE). The facility has application for a capacity of ninety-eight(98), 88 non-ambulatory and 10 bedridden delayed egress clients and the current census is seventy-eight (78) residents.

The pending application is for Residential Care Facility for Elderly (RCFE). This is an application for change of ownership (CHOW).

The physical plant, in general, was in good repair. The buildings and grounds are free from hazards. The indoor and outdoor passageways are free of obstruction. There are firearms, or ammunition. All bedrooms are furnished with a bed, night stand, dresser, and chair. All bedrooms have adequate lighting for resident use. Bathroom's toilet, shower and tubs are in good repair and have non-skid mats. LPA measured and observed the water temperatures in the bathrooms to be at 115 degrees F. LPA observed food storage and preparation areas to be clean and sanitary. Refrigerator and freezer are maintained at appropriate temperatures.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GARDENS OF RIVERSIDE, THE
FACILITY NUMBER: 335530134
VISIT DATE: 01/16/2025
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All appliances are clean and operating properly. Dishes, glasses, and utensils were in good condition. There is a sufficient supply of linens, towels, and personal hygiene items. The first aid kit was reviewed; all items are present. The backyard is completely enclosed with functioning gate to exit to front yard. The outdoor space is suitable for client use. LPA observed fully charged fire extinguisher present in the facility. Smoke alarms and carbon monoxide are present and functional. Facility has a designated area (Med-Room) where medications are stored and locked. The facility had a designated area where staff and client records will be stored. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There is adequate seating in the common areas. Facility had a supply of activities for the clients.

Facility has 1 delayed egress door in Jasmine Building and 4 delayed egress doors in Magnolia Building. facility has any video surveillance.

Pre-licensing inspection is complete, and no corrections are needed to be made. The Comp III presentation was completed during today's visit.

An exit interview was conducted, and a copy of this report was provided to Facility

Administrator/Director-Griselda Garcia.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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