336407734-9-19-2023-18-AS-SMAZ-CVTUZP-20230919160153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336407734
Report Date: 09/19/2023
Date Signed: 09/19/2023 04:01:56 PM

Document Has Been Signed on 09/19/2023 04:01 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:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	39	CENSUS: 38	DATE:	09/19/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	03:03 PM
MET WITH:	Efren Rillo - Administrator		TIME COMPLETED:	04:12 PM

NARRATIVE

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Licensing Program Analyst (LPA) Sara Martinez conducted an announced case management visit to increase the capacity per licensee request. LPA met with Administrator Efren Rillo and Assistant Administrator Earlienne Rillo and explained the purpose of the visit. At the time of visit there were 38 residents.

Licensee requested a capacity increase from thirty-nine (39) residents to forty-three (43) residents. A Fire Clearance was approved on 08/08/2023 for four (4) additional non-ambulatory resident, which of the 4 may also be bedridden. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Martinez discussed the facility sketch with Licensee which provided amble space for 43 residents. LPA Martinez toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA Martinez confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. The facility has 22 bedrooms for the residents with 21 bedrooms containing an attached bathroom. The facility has 4 additional bathrooms located throughout the facility. LPA Martinez additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms.

The physical plant is ready for increase in capacity. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee.

An exit interview was conducted where this report was discussed with and a copy was provided to Efren Rillo.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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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