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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800110
Report Date: 06/27/2024
Date Signed: 06/27/2024 03:12:11 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/27/2024 03:12 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HAPPY NEST IVFACILITY NUMBER:
331800110
ADMINISTRATOR/
DIRECTOR:
CAMUA, GEORGEFACILITY TYPE:
740
ADDRESS:1725 N WHITEWATER CLUBTELEPHONE:
(760) 699-7922
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY: 6CENSUS: 0DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Claire Camua - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to conduct the required annual inspection. LPA was granted entry and met with Administrator Claire Camua who stated the facility does not have residents at the home. The facility has not had any residents since June 13 2024. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following:

Physical plant, floors, windows, and doors were observed to be clean and fixtures and furniture were in good repair and were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature met department requirements. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Facility contains an updated Infection Control Plan and Emergency and Disaster plan. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Laundry room contained locked cabinets to store cleaning supplies, soap, and detergents. Centrally stored medication will be locked in a cabinet located in the living room. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and first aid kit with all required items. observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. LPA reviewed two (2) staff files and training. All staff have the required personnel records on file and criminal record clearance and updated training along with CPR/First Aid.

No deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations.

An exit interview was conducted where a copy of this report was provided to Administrator Camua.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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