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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426760
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:33:19 PM


Document Has Been Signed on 09/14/2023 02:33 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:HACIENDA SENIOR LIVINGFACILITY NUMBER:
336426760
ADMINISTRATOR:MARLYA DUNHAMFACILITY TYPE:
740
ADDRESS:161 N HEMET STTELEPHONE:
(951) 927-6817
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:66CENSUS: 18DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sales and Marketing Director, Angela JonesTIME COMPLETED:
02:30 PM
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On 9/14/2023, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Sales and Marketing Director, Angela Jones who was informed of the purpose of the visit. LPA toured the facility’s interior and exterior with Director Jones. During the visit, there was six (6) staff and 18 residents present.

The facility is made up of two (2) buildings and is approved for delayed egress. One building is designated for assisted living and the other building is designated for residents that require a higher level of care. The facility is licensed for 66 non-ambulatory residents, of which five (5) may be bedridden. LPA was informed that resident apartments are currently getting upgraded and as a result, various apartments are vacant.

During the tour, LPA observed the following:

LPA observed fire alarm systems, carbon monoxide detectors and fire extinguishers throughout the facility. The outside area provides shaded seating available for resident use. Indoor and outdoor passageways are free of obstruction. There are no bodies of water on the premises. LPA toured the kitchen. Food was stored in a safe and healthful manner. Facility met Departmental requirements for 2-day perishables and 7-day non-perishable food items. The facility has large dining rooms and other areas throughout the building for residents to sit and relax. Medications are secured in medication carts, only accessible to authorized personnel such as medication technicians and the administrator.

Continued on LIC809-C..

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HACIENDA SENIOR LIVING
FACILITY NUMBER: 336426760
VISIT DATE: 09/14/2023
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Continued from LIC809..

Cleaning solutions, knives and sharp instruments are secured and inaccessible to residents. Staff present had criminal background clearance on file and were associated to the facility. The facility's last fire drill was held on 7/20/2023.

During today's visit, LPA did not observe any deficiencies. A copy of this report was reviewed and provided to Director Jones.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 248-0350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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