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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423672
Report Date: 10/28/2023
Date Signed: 10/28/2023 01:02:49 PM


Document Has Been Signed on 10/28/2023 01:02 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DESERT COTTAGE IIFACILITY NUMBER:
336423672
ADMINISTRATOR:ELIZABETH HENGSTLERFACILITY TYPE:
740
ADDRESS:83-421 MATADOR COURTTELEPHONE:
(760) 342-7767
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 1DATE:
10/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:ADMINISTRATOR, DESTINY VILLALTATIME COMPLETED:
01:18 PM
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On October 28, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection and met with the Administrator, Destiny. The LPA introduced herself, and stated the purpose of the visit.

LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside. There were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single story home, located at 83-421 Matador Court Indio Ca 92203.

Physical Plant: The facility phone number is(760) 289-6287, and is operable. The LPA observed the resident's bedroom, and it was equipped with required furniture as per Title 22. The LPA inspected the facility bathrooms, and the hot water temperature tested within regulations. Bathrooms were clean and appliances were currently operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and one fire extinguisher. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings, which were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated storage space for the resident and staff files.
Medications: were reviewed, and were locked and inaccessible to residents. The overall facility is clean, the furniture is in good condition. The home was organized and free of clutter. The facility air conditioning and other appliances were operable currently at the time of this visit.
Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for the resident at the time of this review. The dishes and utensils were sufficient in supply and stored properly. Care & Supervision: The facility has sufficient staff, one staff at the time of this visit, and no residents currently home. Records Review: The LPA reviewed one resident file, and one staff file. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit.
An exit interview was conducted and a copy of this report was given to the Administrator, Destiny Villalta.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2023
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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