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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880964
Report Date: 02/08/2021
Date Signed: 02/08/2021 02:40:14 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 MS29-26
RIVERSIDE, CA 92507
FACILITY NAME:CADENCE AT RANCHO CUCAMONGAFACILITY NUMBER:
361880964
ADMINISTRATOR:PEREZ, ALEXISFACILITY TYPE:
740
ADDRESS:10459 CHURCH STREETTELEPHONE:
(480) 664-6500
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:117CENSUS: 0DATE:
02/08/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Alexis Perez, DirectorTIME COMPLETED:
02:15 PM
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On 2/8/202121 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced pre-licensing video conference inspection to the facility due to COVID-19. LPA met with director Alexis Perez. The application is for a 117 bed, Residential Care Facility for the Elderly (RCFE) for 117 non-ambulatory residents of, which 5 can be bedridden. The community consists of two neighborhoods: one for assisted living (AL) and one for memory care (MC).

The LPA observed the screening procedures which takes place at the concierge in the main lobby. The LPA observed one apartment in the AL unit and one apartment in the memory care unit. The apartments includes a kitchen with a dishwasher, living room, eating area, and bathroom. The MC apartments are equipped with stackable washing machine/dryer combos. The LPA observed two on-site restaurants, activity areas, living room areas, two salons, a fitness center a wellness center and a locked medication room. LPA observed a sufficient supply of PPE equipment and disinfectants/cleaning supplies, which will be will be locked and kept inaccessible to residents. Fire extinguishers are present throughout the community. First aid kits are available throughout the community. There is a fountain located on the property. A 12 passenger vehicle was observed and appeared to be safe for transportation. There are two courtyards enclosed by the building structure. The fire inspection was conducted and approved.

The facility was evaluated in accordance with California Code of Regulations (CCR) Title 22. The facility appears to be ready for licensure.

An exit interview was conducted, and a copy of this report was reviewed and provided to Alexis Perez via email to obtain signature.
SUPERVISOR'S NAME: Edna MusokeTELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte HenryTELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2021
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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