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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424584
Report Date: 07/29/2024
Date Signed: 07/29/2024 05:05:45 PM


Document Has Been Signed on 07/29/2024 05:05 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:BLESSED ELDER CARE, INC.FACILITY NUMBER:
336424584
ADMINISTRATOR:MAGDALINA GURAUFACILITY TYPE:
740
ADDRESS:5041 SIERRA ST.TELEPHONE:
(951) 588-6533
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:12CENSUS: 11DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Magdalina Gurau, AdministratorTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection to the facility. The LPA was allowed entrance into the facility and met with Administrator, Magdalina Gurau. The LPA informed the Administrator of the purpose for the visit. The inspection included the following:

Physical Plant: The facility consists of eight (8) resident bedrooms, seven (7) bathrooms, three (3) storage areas, two kitchen and dinning areas, one (1) living space, a laundry room, and a patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Administrator Gurau, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways are kept free of obstruction and are 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 or strips present. The carbon monoxide device was tested by the Administrator and was observed to be in operating condition. The smoke detectors are currently being monitored by Troy Alarm and was the last inspection on file was from 12/22/2023. The home was kept exceptionally clean, organized and free of any odors.

Food Service: There is a minimum of 2 days supply of perishable foods and 1 week's supply of non-perishable foods available. Sufficient dinning supplies were available for residents in care. A variety of food was available and stored in a safe and healthful manner.

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. Staff responsible for direct care and supervision have current first aid and CPR training. Dementia care training was observed to be available and complete. The facility was not operating beyond the conditions specified on the license. The facility currently has an approved Hospice Waiver for nine (9) residents and there are currently three residents in care receiving
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BLESSED ELDER CARE, INC.
FACILITY NUMBER: 336424584
VISIT DATE: 07/29/2024
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hospice services. There is a disaster and mass casualty plan in place. Proof of emergency drills were observed on file. All records were observed to be well organized and safely secured.

Medication Review: The LPA inspected resident medications. Medications were observed to be well organized, appropriately labeled and inaccessible to unauthorized individuals.

An exit interview was conducted with Administrator Gurau in which this report was reviewed and a copy was provided. No citations were issued during this visit.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC809 (FAS) - (06/04)
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