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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800458
Report Date: 06/08/2021
Date Signed: 06/08/2021 01:41:20 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:ADVANTAGE CARE FACILITYFACILITY NUMBER:
361800458
ADMINISTRATOR:TORRES, MELVINFACILITY TYPE:
740
ADDRESS:27438 STRATFORD STREETTELEPHONE:
(909) 910-5629
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:6CENSUS: 6DATE:
06/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Melvin TorresTIME COMPLETED:
02:00 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) Pauline Beschorner arrived at the facility on June 8, 2021 at 12:55 PM to conduct an Annual/Required Visit. Upon LPA arrival, caregiver Marlene Belardo greeted LPA at the door and granted LPA entrance into the facility. Administrator Melvin Torres was called and arrived at the facility approximately 5 minutes later. Torres accompanied LPA on a tour of the inside and outside of the facility and the following was observed:

All staff and residents have been vaccinated. All staff are wearing a surgical mask while working at the facility. Torres stated that staff are tested for COVID at least monthly. Torres stated all staff will be going again to be tested in June but were tested in May. LPA observed a sufficient amount of PPE for the facility. LPA observed surgical masks, gowns, hand sanitizer, and face shields present.

LPA observed all COVID signs present including hand washing, donning and doffing of PPE, visitation policy and cough etiquette. LPA observed 5 residents in total. One resident was outside, while the other residents were resting in their rooms.

Visitors are screened at the front door for temperature and COVID screening questions are asked. Visitors are asked to wash their hands outside before entering into the facility.

The facility provides care to residents with dementia but the facility does not have a designated memory care ward.

An exit interview was conducted and a copy of this report was provided to Administrator Melvin Torres. No citations or technical violations are being issued at this time.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
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