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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904812
Report Date: 04/14/2023
Date Signed: 04/14/2023 01:34:56 PM


Document Has Been Signed on 04/14/2023 01:34 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:PLYMOUTH VILLAGE OF REDLANDSFACILITY NUMBER:
360904812
ADMINISTRATOR:MICHAELS, JULIEFACILITY TYPE:
741
ADDRESS:900 SALEM DRIVETELEPHONE:
(909) 793-1233
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:303CENSUS: 246DATE:
04/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director Julie MichaelsTIME COMPLETED:
02:00 PM
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 Licensing Program Analysts (LPAs) Victoria Chitgian and Bernadette Allen conducted an unannounced annual inspection. LPA's met with Julie Michaels, Executive Director and were provided a tour of the facility. The facility is a Continuing Care Retirement Community and consists of 184 independent homes, a two-story assisted living building with 30 residents, and a memory care building with 10 residents. The license is for 301 non-ambulatory residents and has a hospice waiver for 5 residents. One resident is receiving hospice care services.
The inspection consisted of a review of the assisted living building, kitchen, dining rooms, fitness center, library, reception area, laundry and housekeeping, the beauty salon and an inspection of the memory care unit, including resident rooms and bathrooms, kitchen, living areas and outside gardens.
The facilities have hard wired smoke and carbon monoxide detectors in each resident apartment, emergency lighting, bedroom call buttons, telephone and provision of sufficient lighting. The facility has sufficient towels and linens for resident’s use. The bathrooms were equipped with grab bars and non-slip mats for resident’s safety. Hot water was measured in several rooms and measured between 105-120 degrees as required. The property has a pool which is properly gated and secured for residents’ safety.
The memory care unit has door alarms and locked perimeter gates in the garden area as approved by the Fire Marshall. The facility kitchen was observed to be clean, safe and sanitary and has the required two days of perishable and seven days of non-perishable food supply for residents. The facility had a variety of food available for residents with special dietary needs with healthful options. There is a Dietician on site who provides dietary services. LPA's observed the menu's, activities schedule, ombudsman poster, and complaint poster posted in the assisted living building.

The facility was in compliance with Title 22 regulations and no deficiencies were issued or observed during the inspection.
A copy of this report, LIC 809, was reviewed with and provided to Julie Michaels at the end of the visit.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Victoria ChitgianTELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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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