336409884-7-20-2023-18-AS-JROO-CTWSQ4-20230720140408

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336409884
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:04:12 PM

Document Has Been Signed on 07/20/2023 02:04 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:	ABELLA ADULT RESIDENTIAL FACILITY-V		FACILITY NUMBER:	336409884
ADMINISTRATOR:	LOURDES ABELLA		FACILITY TYPE:	735
ADDRESS:	26957 CAMPUS POINT DRIVE		TELEPHONE:	(951) 485-4230
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY: 6		CENSUS: 4	DATE:	07/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Caregiver Lourdes Abella		TIME COMPLETED:	02:30 PM

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On 7/20/2023, at 1:20 p.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Caregiver, Lourdes Abella who was informed of the purpose of visit. During the visit, there was one (1) staff present who informed LPA that the four (4) clients residing in the home were at day program.

The facility is approved to care for six (6) ambulatory clients and serves adults ages 18-59. LPA toured the facility inside and out with Caregiver Abella. During the visit, LPA observed the following:

Kitchen: LPA observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. LPA observed food supply met the requirement for a two-day supply of perishable food and seven-day supply of non-perishable food. Knives/sharps are secured in a locked kitchen closet.

Dining and Living room: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good repair. Activities and board games are available for clients in care.

Hallway: LPA observed hallway to be clean with no pathway obstructions. Carbon monoxide & smoke detectors were tested and functioning properly. Fire extinguisher is charged and mounted near entrance hallway.

Continued on LIC809-C..

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ABELLA ADULT RESIDENTIAL FACILITY-V	FACILITY NUMBER: 336409884
	VISIT DATE: 07/20/2023

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Centrally Stored Medications: LPA observed a first aid kit with required components. Medications were secured in a closet near the kitchen. LPA reviewed physical medications for the residents as well as the Medication Administration Record (MAR) used to log administration of residents’ medications. No discrepancies discovered in the MAR.

Bedrooms: Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting.

Bathrooms: Bathrooms have a working toilet, wash basin, and the hot water temperature measured at 108- and 111-degrees Fahrenheit. The facility has clean towels, blankets, and linen, available in different colors for the clients in care.

Laundry/Garage: LPA observed laundry room and garage to be clean. Washing machine and dryer are in good repair. Cleaning solutions and chemicals are secured in locked garage cabinet. Emergency food supplies, water, additional linen, PPE, and incontinent supplies are stored in the garage.

Records: Staff present has a criminal record clearance on file and is associated to the facility. Staff training is up to date.

Yard/Outside Area: Covered patio seating is available for clients. A brick wall secured the entire backyard. All outdoor pathways were free of obstructions. No bodies of water were observed. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises.

During this visit, LPA did not observe any deficiencies.

An exit interview was conducted, and a copy of this report was reviewed and provided to Caregiver Abelle.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023

LIC809 (FAS) - (06/04)

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