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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425644
Report Date: 10/28/2023
Date Signed: 10/28/2023 11:09:26 AM


Document Has Been Signed on 10/28/2023 11:09 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:DESERT QUEEN SENIOR HOME CAREFACILITY NUMBER:
336425644
ADMINISTRATOR:MANUEL GOMEZ/QUEENE CUASAYFACILITY TYPE:
740
ADDRESS:29635 SANTA ROSA STREETTELEPHONE:
(760) 328-5129
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 5DATE:
10/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:ADMINISTRATOR, QUEEN CUASAYTIME COMPLETED:
11:20 AM
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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, Queenee. 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 29635 Santa Rosa St. Cathedral City, Ca. 92234.
Physical Plant: The facility phone number is(760)328-5129, and is operable. The LPA observed the resident bedrooms, and they are 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. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and two fire extinguisher. The LPA observed required postings such as; the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings 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 residents at the time of this review. The dishes and utensils were sufficient in supply and stored properly. Care & Supervision: Facility has sufficient staff, four at the time of this visit, and staff were engaging the residents, and providing the morning meal. Records Review: The LPA reviewed five resident files, and four staff files. 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, along with the LIC 811, was given to the Administrator, Queenee.
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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