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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880940
Report Date: 08/17/2024
Date Signed: 08/17/2024 01:57:48 PM


Document Has Been Signed on 08/17/2024 01:57 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:ENJOYCARE-PECANFACILITY NUMBER:
361880940
ADMINISTRATOR:BOLING, NIRMALA JOYFACILITY TYPE:
740
ADDRESS:11599 PECAN WAYTELEPHONE:
(909) 253-1355
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 6DATE:
08/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Nirmala Joy BolingTIME COMPLETED:
02:00 PM
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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 Administrator, Nirmala Joy boling 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 (6) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

The facility's indoor and outdoor passageways were free of obstruction. The facility has no swimming pool or outdoor bodies of water. The facility has a covered outdoor patio area and self-latching backyard gate. The facility is maintained at a comfortable temperature. Fireplace is adequately screened. The facility has operating fire/carbon monoxide alarms and telephone service. Posters such as personal rights, Ombudsman telephone number, Community Care Licensing complaint telephone number, evacuation sketch and emergency phone numbers were posted in a common area.
Facility kitchen and dining areas were maintained clean. The facility has sufficient non-perishable and perishable food supply for the number of residents in care.
Resident’s bedrooms were equipped with beds, bed linen, nightstands, lamps, chairs, and sufficient storage space.
Resident’s bathrooms were equipped with grab rails and operating in safe and sanitary condition. The hot water temperatures tested at 111 degrees F.
Resident’s medications were centrally stored in a locked cabinet and medication records were maintained by the facility.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2024
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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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: ENJOYCARE-PECAN
FACILITY NUMBER: 361880940
VISIT DATE: 08/17/2024
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The facility maintains record of staff’s First Aid Certifications, fingerprint clearances/exemptions, health screenings, and training. The facility maintains records of resident’s admissions agreements, appraisals, medical assessments and plans. The facility administrator's certification and emergency drill training is current.
No deficiencies were cited during today’s visit. An exit interview was conducted, where this report was discussed and a copy 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: 08/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2024
LIC809 (FAS) - (06/04)
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