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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426239
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:06:44 PM

Document Has Been Signed on 11/26/2024 01:06 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:BROOKDALE SUNWESTFACILITY NUMBER:
336426239
ADMINISTRATOR/
DIRECTOR:		THERESA M. WARDFACILITY TYPE:
740
ADDRESS:1085 SUNWEST DRTELEPHONE:
(951) 925-0822
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 60TOTAL ENROLLED CHILDREN: 0CENSUS: 44DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Juanita Jackson - Associate Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit . LPA was granted entry and met with Associate Executive Director Juanita Jackson who was informed of the purpose of the visit. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following:

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 and LPA observed the facility courtyard with outdoor furniture and shaded area for residents. Facility contained PPE equipment and cleaning supplies to do regular cleaning of the facility. Cleaning supplies, detergents, and the sharp and dangerous objects were locked and inaccessible to the residents in care. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The smoke detector, carbon monoxide, and facility sprinkler system was operational and is maintained annually with the last inspection dated 03/29/2024. Facility kitchen had the ability to prepare food in clean environment. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. LPA was informed the facility receives multiple food deliveries a week. LPA observed medication room in Assisted Living was locked and the medication cart lock to be locked and inaccessible to residents in care. MedTechs document medication administration on the facility's electronic Medication Administration Record (eMAR).

LPA reviewed four staff files and training. All staff have the required personnel records on file and criminal record clearance, health screening report, and updated training along with CPR/First Aid Certification. Five (5) resident files were reviewed, and possessed all required paperwork which included their Identification Sheet, Consent Forms, Needs and Service Plan, and updated Physician's Report.
Tricia DanielsonTELEPHONE: (951) 202-5067
Sara MartinezTELEPHONE: (951) 605-0913
DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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: BROOKDALE SUNWEST
FACILITY NUMBER: 336426239
VISIT DATE: 11/26/2024
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Facility has an updated emergency and disaster plan and Infection Control plan. LPA observed all facility exits were clear from obstructions. Facility contained multiple charged fire extinguishers located throughout the facility with an inspection date 11/07/2024. Facility conducts disaster/fire drills with the last drill conducted in 10/2024 which met Department Requirements.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to Associate Executive Director Jackson.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
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