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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412441
Report Date: 03/29/2022
Date Signed: 03/29/2022 10:53:53 AM


Document Has Been Signed on 03/29/2022 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:HALLMARK-PALM SPRINGSFACILITY NUMBER:
336412441
ADMINISTRATOR:GLORIA GOURLAYFACILITY TYPE:
740
ADDRESS:344 NORTH SUNRISE WAYTELEPHONE:
(760) 322-3955
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:55CENSUS: 45DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Angelica Meza, Nursing SupervisorTIME COMPLETED:
10:55 AM
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Licensing Program Analysts (LPAs) Jesse Gardner and Chinwe Nwogene arrived to the facility unannounced to conduct an annual inspection with an emphasis on infection control.

LPAs met with Nursing Supervisor Angelica Meza. Present in the facility during time of visit were 45 residents. There are currently no cases of COVID-19 within the facility.

During today's visit, LPAs toured the facility and made observations pertaining to the facility's infection control measures. LPAs observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities. LPA Gardner later discussed infection control practices and procedures with Ms. Meza.

No deficiencies were noted at the time of visit. An exit interview was discussed with Ms. Meza, and a copy of this report was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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