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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904812
Report Date: 12/31/2024
Date Signed: 12/31/2024 01:43:55 PM

Document Has Been Signed on 12/31/2024 01:43 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:PLYMOUTH VILLAGE OF REDLANDSFACILITY NUMBER:
360904812
ADMINISTRATOR/
DIRECTOR:		MICHAEL HARRISONFACILITY TYPE:
741
ADDRESS:900 SALEM DRIVETELEPHONE:
(909) 793-1233
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: 303TOTAL ENROLLED CHILDREN: 0CENSUS: 277DATE:
12/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Michael Harrison, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Michael Harrison, Executive Director, and discussed the purpose of the visit.

The facility is a Continuing Care Retirement Community with independent homes, a two story assisted living unit, and a memory care unit. The facility has a license capacity of (303) residents and a hospice waiver for (5) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:
Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has sufficient indoor and outdoor space for resident activities. The memory care outdoor activity space is enclosed by perimeter fence gates approved by fire marshall.
Five (5 ) Resident’s bathrooms inspected at random were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured 105 to 111 degrees F. Five (5) Resident’s bedrooms inspected at random have sufficient lighting and furniture in good repair. The facility has operating carbon monoxide alarms, telephone service, laundry equipment and signal system. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in resident common areas, Community Care Licensing complaint posters, Ombudsman posters, facility sketches, and resident monthly activities.
Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerators and freezers are operating in a healthful manner. Pesticides and other cleaning solutions were kept locked and stored away from food areas. The facility has an onsite Dietician, posted menus and sufficient dining areas for residents.
Karen ClemonsTELEPHONE: (951) 248-0349
Bernadette AllenTELEPHONE: 951-897-2618
DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: PLYMOUTH VILLAGE OF REDLANDS
FACILITY NUMBER: 360904812
VISIT DATE: 12/31/2024
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Care & Supervision: The facility has 24-hour/7 days a week care staff. LPA observed several staff assisting with resident care, food service, maintenance and housekeeping.

Record Review: The facility conducted a fire drill on 12/08/23. Five (5) staff files reviewed at random were observed to be complete and included criminal record clearances or exemptions through the Department. Five (5) residents files reviewed at random were observed to be complete.

Medical Related Services: All medication was centrally stored and kept locked in the medication room and appeared to be dispensed as prescribed by their physicians.

Based on LPA observations and file review, the facility was in compliance with Title 22 regulations and no deficiencies were cited during today's visit.

An exit interview was conducted at the conclusion of the visit and a copy of this report was provided to the Executive Director at the conclusion of the visit with appeal rights..
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2024
LIC809 (FAS) - (06/04)
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