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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800184
Report Date: 05/21/2024
Date Signed: 05/21/2024 10:27:01 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/21/2024 10:27 AM - 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:ABUNDANT LIFE SENIOR HOME CAREFACILITY NUMBER:
361800184
ADMINISTRATOR:RONDONUWU, RULLYFACILITY TYPE:
740
ADDRESS:2206 N LAUREL WAYTELEPHONE:
(562) 818-4455
CITY:UPLANDSTATE: CAZIP CODE:
91784
CAPACITY:6CENSUS: 0DATE:
05/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alvin San Diego- AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Alvin San Diego. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (6) current census (0). LPA was accompanied by Facility Administrator Alvin, to conduct an inspection of the outside exterior of the home, which included, but was not limited to, the following:

Physical Plant: During visit, LPA observed fire damage (window boarded),on the room that is located on the south-side exterior of the home. LPA observed that fire damage from the room continued to the roof top perimeter,(no other fire damage was observed besides south-side area),this was due to an electrical fire that took place on 6/1/2023. Redlands Fire Department tagged the facility as unhabitable on 6/1/2023. During the inspection LPA observed that the facility is still unhabital and vacant. Due to the nature of the situation, and because the facility (home) has been red-tagged LPA was only able to conduct an exterior observation of the facility.


Care & Supervision: It was stated by Facility Administrator Alvin San Diego that all residents were relocated following the fire. Alvin was advised by LPA to inform the local Adult and Senior Care Regional Office when the facility is prepared to undergo repairs to make the facility operable again. Once notification is made, LPA will follow-up with Alvin for additional information and/or documents needed.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Alvin San Diego.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola GuerreroTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:
DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2024
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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