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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425810
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:27:20 PM

Document Has Been Signed on 07/30/2024 03:27 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:DANIEL HOMEFACILITY NUMBER:
336425810
ADMINISTRATOR/
DIRECTOR:		ADILENE QUINTANILLAFACILITY TYPE:
735
ADDRESS:30839 VIA PAREDTELEPHONE:
(760) 565-7905
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY: 6CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:27 PM
MET WITH:Staff Nathalia Sanchez and Abigail FlathTIME VISIT/
INSPECTION COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced annual required visit. LPA Flores was granted entry and met with Caregiver Nathalia Sanchez. The facility is licensed for a capacity of six (6) resident to which two (2) may be ambulatory and two (2) non-ambulatory. There are currently four (4) residents in care. All staff present have obtained proper fingerprint clearance and association to the facility. LPA Flores conducted a tour of the interior and exterior of the facility, reviewed facility documents and conducted interviews. LPA Flores observed the following:

LPA Flores conducted a tour of the interior and exterior of the facility and observed all passageways to be free of obstruction. Facility is made up of six (6) bedrooms and three (3) bathroom for residents in care, a kitchen, living/family room, and garage; there are no live in staff. Residents bedrooms were equipped with the required bedding, furniture, and functional lighting. Additional linen and towels are available for clients. There are no pools or bodies of water. Per staff member Abigail Flath, there no known firearms or ammunition on the premises. The facility met the 2-day supply of perishable food and 7-day supply of nonperishable food items. The physical plant was in good repair. Outside area of the facility has a shaded area with available seating. LPA Flores observed two fully charged fire extinguisher, operating smoke alarms, carbon monoxide detectors, and a working telephone. LPA Flores observed several locked areas and cabinets for cleaning solutions, and knives/sharp instruments. There is a locked cabinet located in the kitchen for centrally stored medication.

Facility records review include but are not limited to first-aid training, emergency disaster training, CPR training and more. Staff had criminal record clearance on file along with fingerprint clearance. Resident files were observed to have the required documentation such as physician's report, appraisal, personal rights, and admissions agreement.

An exit interview was conducted where a copy of this report was provided to Staff Abigail Flath.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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