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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800168
Report Date: 10/19/2022
Date Signed: 10/19/2022 11:22:26 AM

Document Has Been Signed on 10/19/2022 11:22 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DULCE VILLA IIFACILITY NUMBER:
331800168
ADMINISTRATOR:MODY, NIKULFACILITY TYPE:
740
ADDRESS:66171 S AGUA DULCE DRTELEPHONE:
(760) 251-4606
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 6CENSUS: 3DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Nikul Mody, Administrator TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA met with Lead Caregiver, Lorena Guillen and Administrator, Nikul Mody who was informed of the purpose of the visit. At the time of visit there was 3 staff and 2 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA Nwogene toured the facility inside and out with Lorena and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towels) in all restrooms. The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA observed PPE supplies.

During the tour, LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home. Administrator, Nikul was informed of the licensing fees due. Nikul stated a check has been mailed to the CDSS office weeks ago. No deficiencies noted at the time of visit.

An exit interview was conducted, and a copy of this report was reviewed and provided to Nikul Mody.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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