336405887-11-21-2024-18-AS-AZEO-DB92XB-20241121164652

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336405887
Report Date: 11/21/2024
Date Signed: 11/21/2024 04:47:15 PM

Document Has Been Signed on 11/21/2024 04:47 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:	INTEGRATED CARE COMMUNITIES - A2		FACILITY NUMBER:	336405887
ADMINISTRATOR/ DIRECTOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14345 NASON STREET		TELEPHONE:	(951) 601-9190
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 19	DATE:	11/21/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 PM
MET WITH:	Victoria Garcis		TIME VISIT/ INSPECTION COMPLETED:	04:50 PM

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Licensing Program Analysts (LPAs) Abdoulaye Zerbo, and Ferrer Sabarias conducted an unannounced visit for a required annual inspection. The LPAs were greeted by the facility managers Victoria Garcia and Miesha Wright, notified them of the purpose for the visit and were allowed to enter the facility to conduct the inspection.

Facility Overview: The facility is a single story building with 12 residents bedrooms, and 13 bathrooms. There is no gated pool and there are no firearms on the premises.

Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in a kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with an expiration date of 07/15/2025. LPAs observed the hot water temperature to meet requirements at 107.6°F.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.

Continued on LIC809-C.....

Rikesha Stamps	TELEPHONE: (951) 212-0616
Abdoulaye Zerbo	TELEPHONE: (951) 248-2222
	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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: INTEGRATED CARE COMMUNITIES - A2	FACILITY NUMBER: 336405887
	VISIT DATE: 11/21/2024

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Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of June 10th, 2026 and a CPR certification with the expiration date of 06-25-26

Record Review and Resident/Staff Files: LPAs reviewed files for six(6) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Six (6) residents' files were reviewed and contained all required documentation. LPAs observed Staff and resident files, to be stored in a locked cabinet. The first aid kit was stored in a cabinet in the office.

Health-Related Services/Incidental Medical Services: All residents' medications were securely locked in a cabinet and located in the medication room. LPAs reviewed medications for four residents, confirming that all medications were listed and accounted for.

Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 11-04-2024, which met department requirements. All facility exits were clear of obstructions.

No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to managers Victoria Garcia and Miesha Wright.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Abdoulaye Zerbo	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC809 (FAS) - (06/04)

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