<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413080
Report Date: 03/04/2024
Date Signed: 03/04/2024 11:26:08 AM


Document Has Been Signed on 03/04/2024 11:26 AM - 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:TUPARAN RESIDENTIAL CARE FACILITY INCFACILITY NUMBER:
366413080
ADMINISTRATOR:TUPARAN, LORETAFACILITY TYPE:
740
ADDRESS:1929 CHURCH STREETTELEPHONE:
(909) 307-1273
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:6CENSUS: 5DATE:
03/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Carina Davis - AdministratorTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Carina Davis, Administrator, and discussed the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) non-ambulatory residents and a current census of (5) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant/Environment: Indoor and outdoor passageways were free of obstruction. The facility has no swimming pools or similar bodies of water. Outdoor area is sufficient for resident activities and is enclosed with a self-latching gate.
The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s showers, toilets, and hand washing areas were operating in a safe and sanitary condition. Resident's bathrooms were equipped with grab rails and shower mats. The hot water temperature in residents' bathrooms measured 115 degrees F. Resident’s bedrooms were equipped with beds, chairs, bed linen, and sufficient lighting. The facility has operating signal systems, carbon monoxide alarms, and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, Personal Rights, Theft and Loss Policy, disaster evacuation plan and emergency telephone numbers. Sharps, disinfectants, and cleaning solutions were kept locked and inaccessible to residents in care.

Care & Supervision: The facility has 24-hour, 7 days a week care staff. Staff working have current CPR/first aid training.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: TUPARAN RESIDENTIAL CARE FACILITY INC
FACILITY NUMBER: 366413080
VISIT DATE: 03/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Food Service: The facility's kitchen and dining areas are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Detergents and other cleaning solutions were kept locked and stored away from food areas.

Record Review: Staff files reviewed were observed to be complete, and included criminal record clearances or exemptions with the Department. Resident files reviewed were observed to be complete. The facility’s liability insurance is current. The facility’s last fire drill was conducted on 3/01/24.

Medical Related Services: Resident’s medications are labeled and centrally stored in a locked closet. The facility has two (2) first aid kits with manuals.

Based on observations and record review, no deficiencies were cited during today’s visit. An exit interview was conducted where this report was reviewed 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: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2