336408433-11-20-2024-18-AS-ACAO-DB82Z2-20241120164938

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336408433
Report Date: 11/20/2024
Date Signed: 11/20/2024 04:50:08 PM

Document Has Been Signed on 11/20/2024 04:50 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:	VISTA COVE AT RANCHO MIRAGE		FACILITY NUMBER:	336408433
ADMINISTRATOR/ DIRECTOR:	JACK POYFAIR		FACILITY TYPE:	740
ADDRESS:	70201 MIRAGE COVE DRIVE		TELEPHONE:	(760) 324-4604
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY: 68	TOTAL ENROLLED CHILDREN: 0	CENSUS: 47	DATE:	11/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:20 PM
MET WITH:	Jack Poyfair, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

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On 11/20/2024, Licensing Program Analysts (LPAs), Andrei Castillo and Seo Jeon arrived at the facility unannounced to conduct the required annual inspection. Upon entry, LPAs were greeted by Executive Director, Jack Poyfair and informed him of the purpose of the visit. At the time of the visit, there were ten staff members and forty seven residents present. LPA conducted a tour of the facility with the Executive Director, reviewed facility documents and conducted interviews. The following is a summary of the visit:

Facility Overview: The facility has two buildings with total thirty bedrooms and eighteen bathrooms. Resident bedrooms had the required bedding, furniture, and lighting. Facility sketch, exit routes, personal rights, “If you See Something, Say Something,” LTC Ombudsman, complaint information and emergency phone numbers were observed posted in the facility. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care.

Infection Control: There were hand hygiene and hand washing stations, 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: Floors, windows, and doors were clean and well-maintained. Furniture and fixtures were in good condition. The outdoor areas were free of hazards and have shaded areas with outdoor furnitures. Laundry equipments were in good working condition. LPA observed fully charged fire extinguishers. Disinfectants, cleaning solutions, and sharp and dangerous objects were securely locked and inaccessible to residents.

Cont. LIC 809-C

Rikesha Stamps	TELEPHONE: (951) 212-0616
Andrei Castillo	TELEPHONE: 951-248-2222
	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

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: VISTA COVE AT RANCHO MIRAGE	FACILITY NUMBER: 336408433
	VISIT DATE: 11/20/2024

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The annual fire extinguisher service maintenance was done on 10/11/2024 by a licensed fire marshal. The hot water temperature was measured at 120°F which is within the required limits. Safety night lights were observed throughout the facility. There were no bodies of water located on the property. According to the Executive Director, there are no firearms or ammunition on the premises.

Food Service: The facility’s kitchens were 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.

Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. Administrator’s license is posted in the facility with an expiration date of 10/22/2025.

Record Review and Resident/Staff Files: LPA reviewed files for four staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five resident files were reviewed and contained all required documentation.

Health-Related Services/Incidental Medical Services: All resident medications were securely locked. LPA reviewed medications for five residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for.

Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, the fire drill was last conducted on 10/11/2024. All facility indoor and outdoor passageways and exits were clear of obstructions and or debris.

No deficiencies were found during the visit. An exit interview was conducted, and a copy of this report was reviewed and given to Executive Director, Jack Poyfair..

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Andrei Castillo	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024

LIC809 (FAS) - (06/04)

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