336426054-9-9-2022-18-AS-CCON-CJ4NM7-20220909103440

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336426054
Report Date: 09/09/2022
Date Signed: 09/09/2022 10:34:50 AM

Document Has Been Signed on 09/09/2022 10:34 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:	CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER		FACILITY NUMBER:	336426054
ADMINISTRATOR:	WILKIN, RONDA		FACILITY TYPE:	740
ADDRESS:	47805 CALEO BAY DRIVE		TELEPHONE:	(760) 771-6100
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	66	CENSUS: 60	DATE:	09/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tammy Eddy - Business Office Manager		TIME COMPLETED:	10:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Business Office Manager Tammy Eddy and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Business Office Manager Tammy Eddy and inquired about if the facility has an Infection Control Plan that LPA Colvin could view, as there is not one on file with Licensing. Business Office Manager Tammy Eddy provided LPA Colvin with a binder which indicated it contained the Infection Control Plan, but when LPA Colvin looked through the binder, there was only a hand washing guide and training for staff in relation to infection control. Prior to the completion of the inspection, Business Office Manager Tammy Eddy was able to produce the facility's Infection Control Policy, which LPA Colvin quickly looked through. LPA Colvin instructed Business Office Manager to submit a copy to the Riverside Licensing Office for the facility's file. LPA Colvin toured the facility and confirmed that residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels, and hand washing guides are posted. Upon entering the facility, LPA Colvin observed postings for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply. LPA Colvin went over the various recommended training for facility staff with Business Office Manager Tammy Eddy in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. Business Office Manager Tammy Eddy confirmed that all staff have been fit tested, and that they will be re-fit tested annually. LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 CENTER	FACILITY NUMBER: 336426054
	VISIT DATE: 09/09/2022

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Business Office Manager Tammy Eddy confirmed that staff are continuing to monitor residents’ symptoms, and that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility, which LPA Colvin confirmed through being screened upon entry as well. LPAs Colvin additionally observed a sign-in log for visitors, where their temperature is recorded as well as answers to screening questions.

Other: LPA Colvin inquired as to who the current Administrator of the facility was, and if the Administrator on file, Ronda WIlkin, still works at the facility. Business Office Manager Tammy Eddy stated that the current Administrator is Maria Arriaga (who LPA Colvin confirmed is associated to the facility) and that Ronda Wilkin is not with the facility any longer (LPA Colvin confirmed this staff is not on the current roster). LPA Colvin requested for the facility to submit an Administrator Packet to Licensing so that the current Administrator can be updated to reflect on the facility's profile, and for the prior one to be removed.

An exit interview was conducted with Business Office Manager Tammy Eddy and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

LIC809 (FAS) - (06/04)

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