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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547200264
Report Date: 06/01/2021
Date Signed: 06/01/2021 03:58:55 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:
06/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Irma MendozaTIME COMPLETED:
03:59 PM
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Licensing Program Analyst (LPA) M. Medina conducted a Case Management visit for the purpose of Health and Safety check of Residents in care. LPA observed one staff working during facility visit. LPA allowed entrance by Direct Care Staff, Allaney Briggs. Per Allaney Briggs, there is currently one (1) resident receiving hospice services and no home health services. Administrator, Irma Mendoza and Licensee, Mary Ellen Prestage arrived during Case Management visit.

A tour of the facility was conducted. LPA measured water temperature at 108 degrees F. Adequate food supply to meet the needs of residents. Facility observed to be clean and odor free. Facility temperature comfortable.

LPA observed five (5) residents relaxing throughout the facility, in their bedrooms or in the family room.

No deficiencies observed during this visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
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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