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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880648
Report Date: 08/19/2021
Date Signed: 08/19/2021 02:17:10 PM

Document Has Been Signed on 08/19/2021 02:17 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CARING HEARTS FOR ELDERLYFACILITY NUMBER:
331880648
ADMINISTRATOR:AGRESOR, MAY-ANNFACILITY TYPE:
740
ADDRESS:73560 WOODWARD DRTELEPHONE:
(760) 333-2760
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY: 6CENSUS: 4DATE:
08/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Fida AgresorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for an annual inspection. LPA met with caregivers Fida Agresor and Segundina Edwards.

LPA toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detectors. Cleaning supplies, medications, and sharps were kept safe. Cleaning supplies were kept in the garage. Medications and sharps are kept in locked cabinets. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The facility menu was available for review. The resident bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items.

LPA observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, clients, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents. LPA observed hand sanitizer throughout the facility and a 30 day supply of PPE. All residents have at least a 30 day supply of medications. LPA observed that all emergency contact information is viewable in the kitchen and dining areas.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Agresor.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2021
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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