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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424582
Report Date: 08/18/2023
Date Signed: 08/18/2023 03:59:14 PM


Document Has Been Signed on 08/18/2023 03:59 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:PEACE AND JOY ELDER CARE IIFACILITY NUMBER:
336424582
ADMINISTRATOR:CECILE JIMENOFACILITY TYPE:
740
ADDRESS:26401 CHAMBERS AVENUETELEPHONE:
(951) 672-9958
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:6CENSUS: 6DATE:
08/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Favie Jimeno, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an required 1 year visit. LPA was granted entrance by Administrator, Favie Jimeno. The facility is a five (5) bedroom two (2) bathroom one story home. LPA conducted staff and resident interviews.

During the tour the following was observed: Required accommodations in resident bedrooms and bathrooms. Fixtures and furniture for an operational facility are present and in good repair. Handrails are securely fastened, grounds are free from hazards. All bedrooms are adequately furnished and in good repair. All passageways were free of obstructions, charged fire extinguishers and the fire alarm system was operable, medications are kept centralized and locked, hazardous items are kept inaccessible to dementia residents. Hot water was tested at 114.5 degrees.
Kitchen/Food Service: LPA observed entire kitchen, food is stored properly and dishes are clean. There is a sufficient supply of perishable and non-perishable foods. Area was observed to be functional and clean.
Care & Supervision: Facility has sufficient care staff.
Administration: Emergency exiting plans, telephone numbers and Ombudsman information are posted. Fire drills are conducted quarterly.
Record Review and Resident/Staff Files: Current staff has Criminal Clearance and CPR/First Aid certification as well current training.
Resident records were reviewed and contained required documents.
Medication Review: LPA reviewed medication and medication log. Residents' medications are being dispensed according to physician's orders.

No cited deficiencies per Title 22, Division 6 of the California Code of Regulations cited at this time. Exit interview conducted and a copy provided to Administrator Favie Jimeno.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
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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