336426083-6-26-2023-18-AS-CGOH-CT6VGM-20230626162548

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336426083
Report Date: 06/26/2023
Date Signed: 06/26/2023 04:25:51 PM

Document Has Been Signed on 06/26/2023 04:25 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	ATRIA PARK OF VINTAGE HILLS		FACILITY NUMBER:	336426083
ADMINISTRATOR:	MARIANO Q. HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	41780 BUTTERFIELD STAGE RD		TELEPHONE:	(951) 506-5555
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92592
CAPACITY:	143	CENSUS: 142	DATE:	06/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:23 AM
MET WITH:	Quinn Hernandez		TIME COMPLETED:	04:26 PM

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), Cheryl Goodrich made an unannounced visit to the facility to conduct an annual inspection focused on the annual inspection. LPA was greeted and granted entry by Executive Director, Quinn Hernandez who was informed of the purpose of the visit. At the time of visit there was 97 staff and 142 residents present. Infection Control: The LPA observed the hand washing signs in and handwashing stations the facility restrooms. LPA observed gloves and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. LPA observed than a 30-day supply of PPE found in the basement. Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed pool and a jacuzzi which was fenced in which met the height requirements. LPA observed the facility outdoor furniture available for the residents use. Laundry room was observed to be locked and was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The Backup generator has been inspected and in good condition with the next inspection date of 10/11/23. Buildings and Grounds: The facility consists of memory care facility and adult living facility. Memory Care consists of one floor for memory care with waiver in place. Each bedroom in memory care has community showers. The Adult Living consists of 3 floors for residential living with single and double bedroom with private showers. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATRIA PARK OF VINTAGE HILLS	FACILITY NUMBER: 336426083
	VISIT DATE: 06/26/2023

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Care & Supervision/Administration: Adequate staff are present for the supervision of clients. Emergency exiting plans, telephone numbers and personal rights were found posted in the facility. The listed administrator possesses a current administrator's certificate.

Storage and Supplies: Medications are be stored in the medication rooms on the second floor, inaccessible to any unauthorized individuals. Secured areas are available for administrative facility files and client files are in the business office and medical files are available in the medication staff office. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in a secured closet, adjacent to kitchen, staff carts and maintenance office. Linens, and equipment appeared to be in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged.

Forms: The following signs were observed to be posted at the facility: Emergency Disaster Plan (LIC 610E), Personal Rights, and Facility Sketch (LIC 999).

An exit interview was conducted, and a copy of this report was reviewed and provided to Executive Director, Quinn Hernandez

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl Goodrich	TELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC809 (FAS) - (06/04)

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