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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880996
Report Date: 09/27/2021
Date Signed: 09/27/2021 12:56:35 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:TAMARIND SENIOR CARE, LLCFACILITY NUMBER:
361880996
ADMINISTRATOR:RAMAS, SOTERO CHANDLER IIIFACILITY TYPE:
740
ADDRESS:9545 TAMARIND AVETELEPHONE:
(909) 346-0292
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:6CENSUS: 3DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Harvy Ortiz CampoTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to facility to conduct an annual inspection, with emphasis on infection control. LPA Brown was greeted and granted entrance by caregiver Harvy Ortiz Campo and explained the purpose of today's visit. Caregiver Harvy Ortiz Campo accompanied LPA Brown on a tour of the inside and outside of the facility. Administrator Chandler Sotero Ramos III was contacted and unable to come to the facility for the inspection.

During today’s visit, LPA Brown made observation pertaining to the facility’s current infection control measures. LPA Brown observed a screening area, proper Covid-19 signages throughout the facility, sufficient hand hygiene supplies, cleaning supplies, and a sufficient supply of Personal Protective Equipment (PPE). The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas/surfaces. The facility also has a plan in place to monitor regularly regularly for any changes in condition and to subsequently notify the resident’s physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses.

Based on the observations made during today’s visit, no deficiencies were cited.
An exit interview was conducted, and a copy of this report was provided to caregiver Harvy Ortiz Ocampo
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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