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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423557
Report Date: 06/28/2024
Date Signed: 06/28/2024 12:41:36 PM


Document Has Been Signed on 06/28/2024 12:41 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:SENIOR HOME PROFESSIONAL CARE 1FACILITY NUMBER:
336423557
ADMINISTRATOR:CORNELIO & S. EVANGELISTAFACILITY TYPE:
740
ADDRESS:45010 DESERT FOX DRIVETELEPHONE:
(760) 834-8140
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:6CENSUS: 4DATE:
06/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jennifer Collera, ManagerTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the facility. The LPA was allowed entrance into the facility and met with Manager, Jennifer Collera. The LPA informed the Manager of the purpose for the visit. The facility currently has an approved Hospice Waiver for three (3) residents. The inspection included the following:
Physical Plant: The facility consists of three (3) resident bedrooms, one (1) staff bedroom, an open kitchen, a dinning area, a sitting room, a laundry area, a garage and storage areas, and a patio with sufficient seating and space for activities. The home does have a pool and the gate was observed to be locked. According to Manager Collera, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways were kept free of obstruction and were free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats present. The carbon monoxide and smoke detectors were tested by facility staff and were observed to be in operating condition. The hot water was tested and found to be within regulatory requirements. The home was kept clean and free of any odors. The home was kept in good repair. Food Service: There is a minimum of 2 days of perishable foods and 1 week's supply of non-perishable foods available. Sufficient supplies were available for resident use. The kitchen was observed to be maintained in a clean state. Record Review: All staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Personnel records were reviewed; staff responsible for direct care and supervision have current First Aid/CPR and medication training on file. Resident records were reviewed; medical assessments and admission agreements were observed to be available. Files were reviewed for all residents receiving hospice services. There is a disaster and mass casualty plan in place and training on the plan has been completed. All records were well organized. Medical Related Services: The LPA inspected resident medications and storage areas. Storage areas were observed to be clean and well organized. Refrigerated medication is being properly stored and secured.
No citations were issued during the visit. This report was reviewed with Manager Collera and a copy was provided.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2024
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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