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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426054
Report Date: 02/15/2022
Date Signed: 02/15/2022 02:10:30 PM


Document Has Been Signed on 02/15/2022 02:10 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:66CENSUS: 51DATE:
02/15/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sheila Fike, AdministratorTIME COMPLETED:
02:15 PM
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On 02/15/2022 at approximately 11:00 am, Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility to conduct a health and safety check. LPA was met with Administrator Sheila Fike and accompanied LPA on a tour of the facility.

Currently the facility has 51 residents in care. There are no firearms or ammunition. LPA observed the facility was kept at a comfortable temperature during this visit (75 degrees). The bathrooms are equipped with grab bars and non-skid shower mats (which were rolled up) for residents safety. The bathrooms were in operating condition. The resident bedrooms were furnished with bed, closet space and/or dressers, night stands and lighting.
LPA observed the kitchen to be clean and free of odor and food to be stored and prepared in a healthful manner. The kitchen was inspected and noted that food supplies are sufficient to meet Title 22 requirements. The facility has an outdoor area that is shaded with table and chairs for client’s comfort while sitting outside.

LPA observed the resident’s medications are centrally located in a nurses' station area and were secured and labeled in compliance with state and federal laws.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Ms. Fike.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2022
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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