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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425681
Report Date: 09/05/2024
Date Signed: 09/05/2024 04:59:42 PM


Document Has Been Signed on 09/05/2024 04:59 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:STARLIGHT SENIOR LIVINGFACILITY NUMBER:
336425681
ADMINISTRATOR:DANA MATEIFACILITY TYPE:
740
ADDRESS:13718 OVERLOOK DR.TELEPHONE:
(760) 288-7351
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:5CENSUS: 5DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Licensee Dana MateiTIME COMPLETED:
12:40 PM
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On 9/5/24 Licensing Program Analyst's (LPAs) Valerie Flores, Ferrer Sabarias, and Andrei Castillo conducted an unannounced one (1) year required visit. LPA's were granted entry by caregiver, Laura McGowan, who was informed of the purpose of visit. At the time of the visit there were one (1) staff, Licensee/Administrator and five (5) residents present. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA's observed the following during today's visit:

LPA's conducted a tour of the facility with staff member, Laura McGowan. The physical plant contained four (4) resident bedrooms, one (1) staff bedroom, and two (2) bathrooms. The facility has a dining room, kitchen, great room, and a gated backyard. Indoor and outdoor passageways were free of obstruction. There were no bodies of water located on the property. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. LPA's observed an additional refrigerator with perishable and non-perishable foods in the garage along with emergency water. Emergency food is stored in the pantry located in the kitchen. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items are located in the kitchen in a locked drawer. Resident bedrooms had the required bedding, furniture, and lighting. Disinfectants and cleaning solutions were secured in a locked cabinet under the kitchen sink. The smoke and carbon monoxide detectors were tested and were observed to be operable. LPA's observed fully charged fire extinguishers throughout the facility. Bathrooms were equipped with the required railing and non-skid mats. Centrally stored medication was observed in a locked cabinet located in the kitchen.



Continuation on LIC809C...
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024
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


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: STARLIGHT SENIOR LIVING
FACILITY NUMBER: 336425681
VISIT DATE: 09/05/2024
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Staff files reviewed have a criminal record clearance, Activities of Daily Living (ADL) training's, and valid first aid/CPR certification. Resident files included but are not limited to signed admission agreements, appraisals, physician reports, and needs and service plan. Facility sketch, personal rights, see something say something, and LTCO poster are posted on the walls throughout the facility. According to Licensee, Dana Matei, there are no firearms or ammunition on the premises.

During today's visit, LPA's did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to staff, Laura
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2