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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880648
Report Date: 08/01/2022
Date Signed: 08/01/2022 03:03:32 PM

Document Has Been Signed on 08/01/2022 03:03 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:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mary-Ann Agresor - AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Administrator Mary-Ann Agresor and advised her of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Mary-Ann Agresor, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply and is accessible to staff at the front door of the facility, along with sanitizer which visitors are requested to use upon entrance.

LPA Colvin went over the various recommended training for facility staff in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Mary-Ann Agresor stated that they have not conducted fit testing for staff at this time. LPA Colvin will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Administrator Mary-Ann Agresor confirmed that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin confirmed this as LPA Colvin's temperature was taken upon entry to the facility, and LPA Colvin signed in on the visitor log.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 ELDERLY
FACILITY NUMBER: 331880648
VISIT DATE: 08/01/2022
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LPA Colvin inquired with Administrator Mary-Ann Agresor if staff were still screening residents daily for COVID-19 symptoms and checking their temperature, which the Administrator confirmed. LPA Colvin went over proper PPE use for caring for a COVID-19 positive resident, as well as what symptoms to contact 911 for (such as shortness of breath and high fever). LPA Colvin additionally confirmed with Administrator Mary-Ann Agresor that all resident emergency contact information was up to date and that the facility has a 30-day supply of medication for the residents. LPA Colvin additionally observed a white board in the dining room/kitchen area which listed all emergency contact numbers such as local hospitals, Department of Public Health, Emergency Medical Transportation, and others.

No deficiencies cited during today's inspection. An exit interview was conducted with Administrator Mary-Ann Agresor and a copy of this report and LIC9102-TA Advisory Notes was provided
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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