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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881351
Report Date: 09/01/2022
Date Signed: 09/01/2022 01:05:19 PM

Document Has Been Signed on 09/01/2022 01:05 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:ASHER'S RESIDENTIAL CARE FACILITYFACILITY NUMBER:
331881351
ADMINISTRATOR:MALIGAYA, MARK ANTHONYFACILITY TYPE:
740
ADDRESS:1666 SAGEBRUSH ROADTELEPHONE:
(760) 844-0754
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92264
CAPACITY: 6CENSUS: 6DATE:
09/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mark Maligaya, ApplicantTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an announced pre-licensing inspection at the facility. The LPA met with Applicant, Mark Maligaya. There are currently six (6) residents in care.

Application: The change of ownership application is for a Residential Care Facility for the Elderly (RCFE). The fire clearance has been granted for six (6) non-ambulatory residents, of which one (1) may be bedridden.

Buildings and Grounds: The home is composed of six (6) resident bedrooms, two (2) staff bedrooms, seven (7) bathrooms, a laundry room, two living rooms, a kitchen, two (2) dining areas, and front/back yard areas. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable.Hot water temperature measured 107.4 degrees Fahrenheit, which measures within regulatory limits. There are no pools or other bodies of water located at the home. According to Maligaya, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished, and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip flooring available. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order.

Storage and Supplies: Medications will be stored inaccessible to any unauthorized individuals. Secured areas are available for facility, staff, and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored in the supply room, inaccessible to unauthorized individuals. Linens, and equipment are all in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged.

Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked kitchen drawer, available only to authorized individuals.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ASHER'S RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 331881351
VISIT DATE: 09/01/2022
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Forms: The following signs were observed to be posted at the home: Emergency Disaster Plan (LIC 610E),Theft and Loss Policies, Visitors Policy, Personal Rights, Resident/Family Council, Facility Sketch (LIC 999), and Complaint Information.


The following was observed to require correction: Applicant did not have a file for himself, containing the required documents.

The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensure once corrections are received from the applicant. This report was discussed with and a copy provided to Maligaya.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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