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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850484
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:58:45 PM


Document Has Been Signed on 09/16/2024 01:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ARIA ASSISTED LIVING ATASCADEROFACILITY NUMBER:
405850484
ADMINISTRATOR:PATEL, RAKESHFACILITY TYPE:
740
ADDRESS:9525 GALLINA CT.TELEPHONE:
(951) 348-8236
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:15CENSUS: 0DATE:
09/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Rakesh Patel TIME COMPLETED:
02:35 PM
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 At 11:00am on 09/16/2024, Licensing Program Analyst (LPA) Jeffries arrived at the pre scheduled time to conduct the Pre Licensing inspection of the facility. LPA reviewed the Pre Licensing packet and observed a STD-850 (fire clearance) singed and dated on 05/20/2024 for 15 non-ambulatory residents. LPA observed and reviewed Infection Control Plan, Emergency Disaster Plan, and Plan of Operation included with the Pre- Licensing packet.
Licensee and LPA conducted an full tour of the facility inside and outside. LPA noted that this is a 10 bedroom, 5 bathroom facility with living room, dining room, kitchen, sitting room, beauty solon nook, laundry room and a regulation height fenced pool. There are 2 storage areas that include a 4 car garage in the back yard. There is ample area for activities and shade provided by trees. LPA noted that the fenced swimming pool is in regulation compliance however, it is currently being renovated and will prohibit access until renovation is completed. LPA noted that all rooms have bedding, linin, and furniture per regulations. LPA noted that there is an internal sprinkler and fire(smoke) detector system that was recently certified by Mid Coast Fire on 04/30/2024. LPA noted that the carbon monoxide detector in the hallway all tested and was working as tested. LPA noted that all hallways, passage ways and doors were free and clear of obstacle. LPA noted that all appliances were new, operational and in good working condition. LPA noted that facility sharps (knifes, etc.) had a lock box in the kitchen drawer. LPA noted that chemicals were locked in laundry room. LPA noted that the facility has a first aide kit with all regulated items. LPA noted that the facility is using a lock closet near the front door for medication storage that will be located at all times. LPA noted that the facility is clean and in good repair. LPA noted that all required posting are posted in a conspicuous location in the central hallway. LPA noted that the facility gutters were being reconditioned during the inspection and all related construction debit will be removed when gutter repairs are completed. LPA noted no issues, or deficiencies during the full walk through tour of this facility.
Licensee and LPA conducted a review of the Pre Licensing Care tools modules. LPA noted that there were no technical, deficiencies, citations, or issues with the pre-licensing review. LPA also conducted the Component III (COMP III) training with the Administrator. LPA noted that they had no objections to the licensing of this facility.
Exit interview, report read, and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
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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