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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881443
Report Date: 07/27/2023
Date Signed: 07/28/2023 08:51:58 AM

Document Has Been Signed on 07/28/2023 08:51 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:AMBER STREET LLCFACILITY NUMBER:
331881443
ADMINISTRATOR:SUMINSKI, KURTFACILITY TYPE:
740
ADDRESS:72870 AMBER STTELEPHONE:
(415) 722-8475
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 6CENSUS: 0DATE:
07/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Joanne Panuso - LicenseeTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Sara Martinez conducted an announced visit to complete the Pre-licensing inspection. LPA met with licensee Joanne Panuso, for a residential care facility for the elderly with a capacity of six (6) residents.

The facility is a six (6) bedroom, five (5) bath home, kitchen/dining area, one (1) living room area, a laundry room, and backyard. LPA toured the interior and exterior areas of the facility. The following were inspected:



Resident Bedrooms: All bedrooms have the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, lighting, and emergency lighting.

Resident Bathrooms: The bathroom appliances were operating in safe and sanitary condition. The bathrooms have non-slip mats.

Kitchen and Dining Areas: Utensils and dishware are in good repair and ready for client use. Kitchen appliances and counter top were free of debris and in good repair. The knives and sharp objects were locked in the drawers. The water temperature was measured by LPA, the thermometer read at 109 degrees F.

Staff Office: The office consist of two (2) cabinets for client/staff files, and medication.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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: AMBER STREET LLC
FACILITY NUMBER: 331881443
VISIT DATE: 07/27/2023
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Common Sitting Areas: There is adequate seating in the common areas. The facility has a list of activities for the residents.

Laundry Room. : The laundry room is near the dinning room and will have cabinets locked with chemicals and laundry soap.



Linens and Hygiene Supplies: An adequate supply of linens were available.

Backyard: There are no bodies of water in the backyard. There is multiple covered area with seating for the all the residents. All passageways were free from obstruction.

Fire extinguisher, carbon monoxide, firearms: The facility has charged fire extinguishers in the facility. LPA observed operating smoke detectors and carbon monoxide alarms. The home does not have any firearms and ammunition.

Postings: LPA observed required postings including the visitation polices, emergency/disaster plans, complaint procedures, and personal rights.

First aid and working telephone: The facility was equipped with a complete first aid kit and manual. The facility has working telephone for resident use.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA have determined that the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete, and this facility has no deficiencies. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Licensee Joanne Panuso.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC809 (FAS) - (06/04)
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