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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200264
Report Date: 05/19/2021
Date Signed: 05/19/2021 12:12:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:RIVERSEDGE ELDERCAREFACILITY NUMBER:
547200264
ADMINISTRATOR:PRESTAGE, MARY ELLENFACILITY TYPE:
740
ADDRESS:285 SOUTH WESTWOODTELEPHONE:
(559) 788-0611
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:6CENSUS: 5DATE:
05/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Mary Ellen PrestageTIME COMPLETED:
12:23 PM
NARRATIVE
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LPA Medina conducted an unannounced Case Management visit. LPA met with Licensee, Mary Ellen Prestage and explained purpose of visit. Mary Ellen Prestage serves as facility Administrator #6023121740, expires 12/08/2018.

LPA Medina discovered during complaint visit that Licensee does not have a current Administrator Certificate. LPA made a telephone call to the Administrator Certification Unit and there is no application for renewal on file.

Exit interview conducted.

Deficiencies cited on the attached 809D.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
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, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: RIVERSEDGE ELDERCARE
FACILITY NUMBER: 547200264
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2021
Section Cited

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All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person...When the administrator is not in the facility, there shall be coverage by a
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designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. ***This was not met as evidenced by current Administrator certificate is expired.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2021
LIC809 (FAS) - (06/04)
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