<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425070
Report Date: 03/30/2022
Date Signed: 04/14/2022 11:43:20 AM


Document Has Been Signed on 04/14/2022 11:43 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:ELDORADO SENIOR HOMECARE, LLCFACILITY NUMBER:
336425070
ADMINISTRATOR:ANITA C. FLETCHERFACILITY TYPE:
740
ADDRESS:19465 ELDORADO ROADTELEPHONE:
(951) 776-0947
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 1DATE:
03/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Anita Fletcher, AdministratorTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Stephanie Torres, made an unannounced visit to the facility to conduct an annual inspection, with an emphasis on infection control. The LPA met with Administrator, Anita Fletcher, and informed her of the purpose of her visit. There are currently no cases of COVID-19 within the facility.

During today's visit, the LPA toured the interior/exterior areas of the facility and made observations pertaining to the facility's infection control measures. The LPA observed sufficient hand hygiene supplies and sufficient cleaning and disinfecting provisions.

During this visit the LPA observed an uncleared adult in the facility. According to Fletcher, the Uncleared Adult (UA1) used to be a resident, though is no longer. She stated UA1 has been residing in the facility since July 2020, approximately. No admission agreement was observed on file for UA1. Fletcher stated UA1 has not been finger printed in order to obtain a California clearance. Based on this information a citation and civil penalty will be issued.

An exit interview to review this report was conducted with Fletcher and a copy of this report was provided, along with the Appeal Rights.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/14/2022 11:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: ELDORADO SENIOR HOMECARE, LLC
FACILITY NUMBER: 336425070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(1)
CRIMINAL RECORD CLEARANCE: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption...This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in that there was one (1) uncleared adult residing in the home. According to the Administrator, this adult has not been fingerprinted in order to obtain a California clearance. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/30/2022
Plan of Correction
1
2
3
4
This individual was removed from the home prior to the LPA's departure.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2