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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425525
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:07:54 PM


Document Has Been Signed on 03/05/2024 03:07 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:SUNNY ROSE GLENFACILITY NUMBER:
336425525
ADMINISTRATOR:SALAS, DIANAFACILITY TYPE:
740
ADDRESS:29620 BRADLEY RDTELEPHONE:
(951) 679-3355
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:81CENSUS: 69DATE:
03/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, Karen RoperTIME COMPLETED:
03:15 PM
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On 3/5/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to conduct an annual required visit. LPA met with Administrator, Karen Roper who was informed of the purpose of the visit.

The facility is licensed to provide care for six (6) ambulatory and 75 non-ambulatory residents, of which five (5) may be bedridden. The facility also has an approved hospice waiver for 20 residents and is approved for delayed egress. LPA was informed the facility currently has 18 residents receiving hospice services. LPA toured the facility's interior and exterior with Administrator Roper. LPA observed the facility is made of two (2) buildings. The front building is designated for assisted living and the back building is designated for the memory care unit. Administrator Roper tested the delayed egress in the memory care unit and LPA observed it was functional. LPA was informed the facility has a new management company effective 10/18/2023 that is remodeling vacant rooms and adding new flooring to the common areas. During the tour of the assisted living unit, LPA observed residents in their rooms and playing bingo in the dining room. LPA observed residents in the memory care unit building puzzles and watching television in the living room. LPA observed the facility has charged fire extinguishers mounted throughout the facility along with operating fire alarm systems, and carbon monoxide detectors. Indoor and outdoor passageways were kept free of obstruction. The outside of the facility had a shaded area with seating. There were no bodies of water observed on the premises. Fireplaces had appropriate barriers to make them inaccessible to residents in care. Cleaning supplies, disinfectants and sharp instruments were secured in locked areas. Medications were stored in the medication carts inside medication rooms, only accessible to medication technicians.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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: SUNNY ROSE GLEN
FACILITY NUMBER: 336425525
VISIT DATE: 03/05/2024
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LPA toured the kitchen and observed food was stored in a safe and healthful manner. LPA spoke Food Service Director, Marisol Huizar who demonstrated the lactose/gluten free food supply for residents who require a lactose/gluten free diet. LPA observed that the facility had a two (2) day supply of perishable food items and seven (7) day supply of non-perishable food items. LPA toured a sample of the resident rooms. The resident bedrooms had the required furniture and functional lighting. LPA observed grab bars and nonskid mats in the bathrooms. Complaint procedures and facility sketches were posted near the entrance.

During today's visit, LPA did not observe any deficiencies. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Roper.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC809 (FAS) - (06/04)
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