<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427425
Report Date: 07/08/2021
Date Signed: 07/08/2021 01:11:32 PM

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:AMRO ELDERLY CARE HOMEFACILITY NUMBER:
336427425
ADMINISTRATOR:GRAVILONI, DANIELAFACILITY TYPE:
740
ADDRESS:10213 CALIFORNIA AVETELEPHONE:
(951) 785-1869
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:6CENSUS: 2DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Daniela GraviloniTIME COMPLETED:
01:22 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) Christine Le conducted an unannounced visit to the facility for an annual inspection. LPA met with licensee Daniela Graviloni.

LPA toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detectors. Cleaning supplies, medications, and sharps were kept in a safe and locked place. Cleaning supplies were kept in the laundry room and in a cabinet. Medications were kept in a locked cabinet. Sharps were stored in a secured area. The facility had a complete first aid kit and manual. LPA observed two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. The facility menu was available for review. The resident bedrooms had the required furniture and sufficient lighting. The facility had a supply of additional linen and hygiene items. LPA toured the resident bathrooms. LPA measured the hot water temperature in the bathrooms. The hot water temperature measured at 105 degrees F. LPA also observed emergency supplies.

LPA observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, residents, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents. LPA observed hand sanitizer throughout the facility and a 30 day supply of PPE. All residents have at least a 30 day supply of medications. LPA observed that all emergency contact information for the residents have been updated.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Christine LeTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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 1