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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881134
Report Date: 07/08/2021
Date Signed: 07/08/2021 11:20:16 AM

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:ALLARA SENIOR LIVINGFACILITY NUMBER:
361881134
ADMINISTRATOR:HEFNER, LEEANNFACILITY TYPE:
740
ADDRESS:9417 19TH STREETTELEPHONE:
(909) 736-1900
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:120CENSUS: 0DATE:
07/08/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lee Ann HefnerTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Stephanie Williams arrived at the facility to conduct a pre-licensing inspection. LPA identified herself and conducted the visit with Administrator/Executive Director, Lee Ann Hefner.

The pending application is for a Residential Care Facility for the Elderly. The facility has been granted a fire clearance for 100 non-ambulatory residents and 20 bedridden residents by the Rancho Cucamonga Fire Protection District on 6/8/2021. The facility is approved for delayed egress in Memory Care. The facility has a total of 79 Assisted Living bedrooms and 26 Memory Care bedrooms. LPA toured the interior and exterior area of the facility. The following was observed, reviewed, and inspected:

LPA inspected a sample of resident bedrooms in Assisted Living and Memory Care in which all bedrooms were equipped with appropriate furnishings and storage space. LPA inspected resident bathrooms; bathroom appliances were operating in safe and sanitary conditions and were equipped with non-skid mats, grab bars, and pull cord systems. LPA inspected the kitchen; food storage areas and cooking equipment were clean and refrigerator/freezer temperatures were at the appropriate level. In the kitchen, dishes, glasses, and utensils were in good condition and stored in a safe manner. LPA inspected the common/activity areas; LPA observed sufficient activity space for residents. The Administrator confirmed that fire extinguishers, smoke detectors, and carbon monoxide alarms were checked and operating during fire clearance inspection. LPA observed required postings including the Department's complaint poster, resident's personal rights, and the facility's emergency/disaster plan. The facility was equipped with a complete first aid kit as well as the first aid manual. There was a locked and centralized storage area for medications and resident files. The facility had a working telephone for resident use. LPA inspected the outdoor space; there was a shaded seating area for residents.

Overall, the facility was free from apparent health and safety risks at the time of visit. LPA observed that the
facility grounds were clean and in good repair. All passageways and exits were free from obstruction. All
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALLARA SENIOR LIVING
FACILITY NUMBER: 361881134
VISIT DATE: 07/08/2021
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facility utilities were functioning and operating properly. LPA determined that the facility was safe and sanitary for future residents in care.

Pre-Licensing is complete and this facility has no deficiencies. Applicant has satisfied all requirements in accordance with Title 22, California Code of Regulations.

An exit interview was conducted where this report was discussed and a copy was provided to Hefner.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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