331881439-9-26-2023-18-AS-CGOH-CW2PSV-20230926113457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881439
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:35:04 AM

Document Has Been Signed on 09/26/2023 11:35 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	EMERALD ROSE GARDEN 2		FACILITY NUMBER:	331881439
ADMINISTRATOR:	JULIE C. NAVAREZ		FACILITY TYPE:	740
ADDRESS:	74501 COLUMBINE DRIVE		TELEPHONE:	(909) 533-0642
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY: 6		CENSUS:	DATE:	09/26/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Administrator, Julie Navarez		TIME COMPLETED:	11:35 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 10:29AM. to conduct an announced Pre-Licensing visit. LPA met the Co-Owner, Veronica Casem at the front door and was granted entry. LPA spoke with Co-Owner, Veronica Casem and Administrator Julie Navarez and advised the purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) residents, 5 ambulatory residents, 1 bedridden with 0 residents in care. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety: The facility temperature read at 76 degrees. The facility consists of 4 resident bedrooms: 2 bedrooms with 2 beds and 2 bedrooms with a single bed, and 2 bathrooms, living room, kitchen, backyard, and gated pool. The fencing requirement for the pool meets licensing requirements of a minimum of 5 feet. The bedrooms are furnished with lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 106 degrees within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the kitchen and inaccessible to the resident. The facility and has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: There are no staff currently hired at this time. The Co-Owner and Administrator’s records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. (Continued on LIC809-C)

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: EMERALD ROSE GARDEN 2	FACILITY NUMBER: 331881439
	VISIT DATE: 09/26/2023

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(Continued from LIC809)

Client Records-Incident Reports: The facility has no residents in care and does not have any client reports including but not limited to identification and emergency information, physician’s orders, medication logbook, and assessments. The facility does not handle the resident’s cash resources.
Client Rights-Information: The facility has client rights information posted in the facility.
Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available.
Health- Related Services: The facility has a medication logbook; however, no records are present due to no residents in care.
Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 09/15/23. The facility has emergency supply of food and water.
Summary: Based on today's visit, no deficiencies were observed at this time. The Pre-Licensing inspection has been completed. An exit interview was conducted with Administrator Julie Navarez and a copy of this report was printed Signature below confirms receipt of these rights.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Cheryl Goodrich
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC809 (FAS) - (06/04)

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