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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336405788
Report Date: 11/08/2024
Date Signed: 11/08/2024 12:37:31 PM

Document Has Been Signed on 11/08/2024 12:37 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PUTTERS LANE ASSISTED LIVINGFACILITY NUMBER:
336405788
ADMINISTRATOR/
DIRECTOR:		KAREN COCCHIAROFACILITY TYPE:
740
ADDRESS:25858 NEW CHICAGOTELEPHONE:
(951) 663-8514
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Karen Cocchiaro AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analysts (LPAs), Ferrer Sabarias and Abduoulaye Zerbo made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs was greeted and granted entry to the facility to conduct the inspection. On today’s visit the LPAs met with Administrator Karen Cocchiaro ,she was notified of the purpose for the visit.
PHYSICAL PLANT: The Licensee is operating the facility within the conditions and limitations specified on the license. Clients/Residents appear to be protected against immediate hazards. Outdoor and indoor passageways are kept free of obstruction. No pool or body of water was observed on the property. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Toilets, hand washing and bathing in the facilities were kept safe, sanitary, and in operating condition. According to the Administrator no firearms are kept in the home. The interior and exterior areas of the home were observed to be clean and safe. LPAs observed the garage with a couch and a bed. According to Administrator it is a resting/office area. Administrator will send a new floor plan by 11/15/24.
FOOD SERVICE: There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean.
MEDICATION: Medication was reviewed for five Residents in care. All medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to clients in care. Medications and medication documentation was observed to be organized and monitored.
Rikesha StampsTELEPHONE: (951) 212-0616
Ferrer SabariasTELEPHONE: (951) 248-2222
DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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: PUTTERS LANE ASSISTED LIVING
FACILITY NUMBER: 336405788
VISIT DATE: 11/08/2024
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RECORD REVIEW: Staff files had required training; including, but not limited to, first aid and emergency procedures training. Staff present had the required criminal record clearances. Medical Assessment (Physician's Report) was on file for residents in care. Administrator,has an active Administrator's certificate, which expires on 6/28/2025. A windstorm drill were completed on 10/10/2024.

This report was reviewed with Administrator Karen Cocchiaro and a copy was provided. No deficiencies were cited at time of inspection.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Ferrer SabariasTELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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