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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881195
Report Date: 11/01/2021
Date Signed: 11/01/2021 11:23:33 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:PALM VIEW PLEASANT LIVINGFACILITY NUMBER:
361881195
ADMINISTRATOR:KHALID, AMBREENFACILITY TYPE:
740
ADDRESS:710 N CHURCH STREETTELEPHONE:
(909) 328-2118
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:20CENSUS: 0DATE:
11/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ambreen KhalidTIME COMPLETED:
11:45 AM
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On 11/1/2021 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced visit for the purpose of conducting a pre-licensing inspection. Upon arrival, LPA met with Ambreen and Niaz Khalid. Licensee. On 8/11/21 the Redlands Fire Department approved the facility for 20 non-ambulatory residents, of which 20 can be bedridden. The facility is a single story structure with 11 bedrooms, kitchen/dining area, activity area, laundry room and a medication room. There is a COVID-19 mitigation plan on file.

LPA toured the home inside and out. There is a COVID-19 screening station at the front entry. The residents will each be provided an alarm that is connected to a call system. All resident rooms have bathrooms inside. All of the bathroom are quipped with non-skid shower floors and rails. There is one common bathroom across from the office. All bedrooms are appropriately furnished and well lit and has exit doors with operable alarms. LPA observed kitchen, dining room, living room and activity areas. The appliances in the kitchen operate properly. Sharps, cleaners and disinfectants will be kept locked in the kitchen cabinets. The facility is stocked with dishes, glasses, and utensils all in good repair. There is a gated fountain in the center of the court yard. The facility is stocked with a sufficient amount of personal hygiene supplies, and linens available for clients. The facility is stocked with a 2 day supply of perishable, and a 7 day supply of non-perishable food items. The emergency disaster plan, personal rights and complaint procedures, food menu and daily activities are posted in the dining area. The facility has a stocked first aid kit. The facility has a laundry room and laundry supplies that will be inaccessible to residents. The facility has a working land line telephone. There is additional parking at the rear of the facility. The medication room is equipped with a medication cart and both will be kept inaccessible to residents. Staff and resident files will be stored in the office. Water temperature was within the regulated range. Fire extinguishers are located throughout the facility in place and are fully charged. First aid kit was observed and fully stocked. The entire facility has been remodeled and is in excellent condition. There were no deficiencies observed during the inspection. Comp III was completed during the inspection. An exit interview was conducted where this report was provided to Licensee, Ambreen Khalid
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte HenryTELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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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