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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208818
Report Date: 02/22/2025
Date Signed: 02/22/2025 03:16:42 PM

Document Has Been Signed on 02/22/2025 03:16 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:RIVERSIDE SENIOR CAREHOMEFACILITY NUMBER:
107208818
ADMINISTRATOR/
DIRECTOR:
BAUTISTA, ARLENEFACILITY TYPE:
740
ADDRESS:7435 N RIVERSIDE DRIVETELEPHONE:
(559) 412-8684
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 6DATE:
02/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Elisa PuaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 2/22/2025, Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct the Annual Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Caregiver. Elisa Pua, Assistant Administrator contacted by telephone and arrived a short time later to conduct inspection.

During facility visit, LPA toured the facility with Assistant Administrator. Facility observed to be clean, well lit, and odor free. Facility has four (4) private bedrooms and one (1) shared bedroom. Resident bedrooms toured and have required furnishings. Resident bathrooms toured, and observed fixtures to be operational. Water temperature measured at 107 degrees F. Kitchen toured, LPA observed facility to have a 2-day supply of perishable food, and a 7-day supply of non-perishable supply of food available. There is also a supply of emergency food kits stored in the pantry. Kitchen knives observed to be locked and secured under kitchen sink and inaccessible to residents. Medications are centrally stored and locked in kitchen cabinet, medications observed to have original labels and to be administered as prescribed. Laundry room observed to be locked during inspection. All chemicals are locked and secured in laundry room cabinets or locked closet in laundry room. Facility has sufficient linen for residents stored in closet near front of facility. Fire extinguisher present with a purchase date of 5/16/2024. Smoke and Carbon Monoxide detectors present and observed operational during inspection. First Aid kit present and observed to have all regulation supplies.

Outside of facility toured. All exits open free of obstruction, no hazards observed. Exit gate observed to be self-latching.

LPA conducted resident and staff file reviews.

No deficiencies were cited during this inspection. An exit interview was conducted. A copy of this report was signed and left with Administrator for facility records.

LPA received the following documents during facility visit: Register of Facility Client/Residents (LIC 9020), and Current Liability Coverage.

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2025
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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