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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403366
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:39:09 PM


Document Has Been Signed on 01/10/2024 03:39 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:WINDSOR COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:PATRICK MCADOO MORTONFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 127DATE:
01/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Aurelien FruitTIME COMPLETED:
04:00 PM
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During the course of a complaint investigation, in reference to Complaint Control number: 18-AS-20231026092156, Licensing Program Analyst (LPA) Kathleen Banrasavong reviewed staff files and discovered that S1 did not have a TB test result on file with the facility.

In the complaint, the reporting party alleged that TB test were not being regularly asked and checked by the facility. During the course of this investigation, LPA pulled five random staff members’ TB test examination results. 4 out of 5 staff members had their TB test results in their employee files. LPA Banrasavong is issuing a technical violation per Title 22, Division 6 Health and Safety Code 1796.45 (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. There are no health and safety concerns at this time. An exit interview was conducted, a copy of this report, a technical violation was provided to the Administrator, Aurelien Fruit as evidenced by his signature.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024
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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