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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800210
Report Date: 12/17/2024
Date Signed: 12/17/2024 03:52:17 PM

Document Has Been Signed on 12/17/2024 03:52 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:ARIES RESIDENTIAL CARE INCFACILITY NUMBER:
361800210
ADMINISTRATOR/
DIRECTOR:		ROGOVIN, ROBERTFACILITY TYPE:
740
ADDRESS:17892 SYCAMORE STTELEPHONE:
(760) 927-3357
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
12/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Robert RogovinTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Robert Rogovin, Administrator, and discussed the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) and a current census of (3) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. Facility's backyard is sufficient for resident activities; however, LPA observed both latching gates were locked with a pad lock. LPA review of the fire inspection report on file does not specify an approval for a locked perimeter. A deficiency cited.
The facility has sufficient lighting and is maintained at a temperature of 74 degrees F. Resident’s bathroom equipment were fully operational. The hot water temperature in residents' bathrooms measured 119 degrees F. LPA observed in two (2) resident's bathroom, cleaning supplies that were kept unlocked underneath the sink. The Administrator removed the cleaning supplies.
LPA observed postural supports/half bedrails in resident #2 (Room A) and resident #3(Room B) being utilized without a physician's order. LPA observed a full bed in resident #1 (R1's) room C being utilized by R1 without receiving hospice care. The Licensee stated that R1 was a fall risk and supports were used for fall prevention. A deficiency cited. The facility is equipped with smoke/carbon monoxide alarms, laundry equipment, and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, Personal Rights, emergency telephone numbers and evacuation sketch.
Karen ClemonsTELEPHONE: (951) 248-0349
Magda MalcoreTELEPHONE: 951-248-0316
DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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Document Has Been Signed on 12/17/2024 03:52 PM - It Cannot Be Edited


Created By: Magda Malcore On 12/17/2024 at 12:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above by not maintaining cleaning supplies locked and inaccessible to residents in care; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/18/2024
Plan of Correction
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The Administrator removed the cleaning supplies. No further action is required.
Type A
Section Cited
CCR
87705(I)(2)
Care of Persons with Dementia
(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above by maintaining the exterior yard gates locked without proper clearance; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2024
Plan of Correction
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The Licensee shall remove the locks and submit proof of correction by POC due date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME:Magda Malcore
TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/17/2024 03:52 PM - It Cannot Be Edited


Created By: Magda Malcore On 12/17/2024 at 12:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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Type B
Section Cited
CCR
87506(a)
(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above by not maintaining an current centrally stored medication list of resident #2 and resident #3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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The Licensee has agreed to provide an updated centrally store medication record by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME:Magda Malcore
TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/17/2024 03:52 PM - It Cannot Be Edited


Created By: Magda Malcore On 12/17/2024 at 12:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87608(a)(5)(A)
Postural Supports
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above by not maintaining a written physician's order indicating the use for half bed rails for resident #2 and resident #3; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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The Licensee shall submit documentation of physician's order for bed rails by plan of correction date.
Type B
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above by maintaining full bed rails for resident #1 (R1's)(Room C) to use without R1 being on hospice care; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/10/2025
Plan of Correction
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The Licensee shall submit to the Licensing Agency proof of correction by plan of correction date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME:Magda Malcore
TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/17/2024 03:52 PM - It Cannot Be Edited


Created By: Magda Malcore On 12/17/2024 at 02:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(c)(2)
(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observations, the licensee did not comply with the section cited above by not discarding resident #1 (R1) medication by 11/19/24 as indicated and storing with current medications which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2024
Plan of Correction
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The Licensee shall submit a statement of understanding on the regulation cite by POC due date.
Type A
Section Cited
CCR
87465(h)(4)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above by not maintaining a prescribed medication for resident #3(R3) without a prescription label in resident's medication; which poses an immediate health, safety or personal rights risk to persons in care
POC Due Date: 12/19/2024
Plan of Correction
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The Licensee shall submit a statement of understanding on the regulation cited by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME:Magda Malcore
TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


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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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210
VISIT DATE: 12/17/2024
NARRATIVE
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Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care.
The facility has sufficient supply of cups, plates and utensils for residents.

Care & Supervision: Facility has 24-hour, 7 days a week care staff. Staff working have criminal record clearances through the Department.

Record Review: Staff files were reviewed for criminal record clearances, Employment records, job training, health screenings and first Aid/CPR training. Resident files were reviewed for admissions agreements, physician's reports, appraisals and safeguarded resource records. The facility’s Administrator’s certification and liability insurance are current. The facility’s last fire drill was conducted on 11/24/24. The facility did not have a current emergency and disaster Plan on file. Deficiency cited.

Medical Related Services: Resident’s medications were centrally stored in a locked cabinet. LPA observed the Licensee did not maintain a current/updated centrally medication record for R2 and R3, as not all prescribed medication were on listed on record. LPA observed in R1's current medication box, a medication with the prescription label stating discard after 11/19/24. The Licensee stated that the resident is no longer taking the medication. LPA requested all three resident's daily medication log from the Licensee. The Licensee stated that the medication log was currently at their other home for updating.

Based on observations and record review, deficiencies were cited and technical advisories were issued per Title 22, of The California Code of Regulations and Health and Safety codes.

This report and correction plans were reviewed with the Administrator and a copy with Appeal Rights was provided to the Administrator at the conclusion of the visit.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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