331881518-4-18-2024-18-AS-VMIN-D4FTUA-20240418150158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881518
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:03:27 PM

Document Has Been Signed on 04/18/2024 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:	BOUNTIFUL GARDENS		FACILITY NUMBER:	331881518
ADMINISTRATOR/ DIRECTOR:	WHITE, MALCOLM E		FACILITY TYPE:	740
ADDRESS:	291 BRANDON WAY		TELEPHONE:	(619) 347-2140
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY: 6		CENSUS: 0	DATE:	04/18/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	ADMINISTRATOR, MALCOLM E WHITE		TIME VISIT/ INSPECTION COMPLETED:	12:58 PM

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	On April 18, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a Pre-Licensing inspection. LPA Mixson met with the Administrator, Malcolm White introduced herself, and stated the purpose of the visit. Physical Plant: The location is a single-story home located at 291 Brandon Way and has six bedrooms, three full bathrooms, a living room, dining room, and a kitchen, with a two-car garage. A backyard and front yard. The Hemet Fire Department approved this facility for six non-Ambulatory, zero-Ambulatory, and zero bedridden residents, on January 18, 2024. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate is current and will expire on 08/05/2024. Medication:LPA Mixson observed where medications are to be stored, locked, and inaccessible to the residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed and are operable. LPA Mixson observed the fire extinguisher, it was charged and in the green. The cleaning supplies were locked and inaccessible, along with the sharp objects and the Administrator informed the LPA there are no firearms on the premises. Bedrooms: The bedrooms were large enough to allow for easy passage between the beds, and other required items of furniture were present currently at the time of this inspection. To include a chair, nightstand, and sufficient lighting for future residents. Kitchen/Food: The knives were locked in a kitchen drawer, plenty of pots, pans, and other kitchen accessories. The facility has the required seven-day supply of non-perishable food items and the two-day supply of perishable food items. LPA Mixson observed hygiene supplies for residents. There were no pesticides, poisons, or other toxic substances stored in any food storage or preparation area currently at the time of this inspection. (87555).

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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: BOUNTIFUL GARDENS	FACILITY NUMBER: 331881518
	VISIT DATE: 04/18/2024

NARRATIVE

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CONTINUATION
Records: There is confidential storage space for personnel records at the time of this visit. (87412). Bathrooms: The bathrooms floors were clean and sanitary and free of odors, water and other appliances were operable, water temperature tested within regulations. There was at least one toilet and sink for each six persons to include residents, family, and personnel. (87307), and at least one bathtub/shower for each ten persons which includes residents, family and/or live-in personnel. (87307). Administration: LPA Mixson observed emergency exiting plans and telephone numbers posted, Personal Rights, Complaint Poster, and other required documents were posted currently at the time of this visit, along with the current Administrators certification. The facility theft and loss program policy are posted, currently at the time of this inspection. (87218). Activities: There are activity supplies and equipment, including access to daily newspapers, current magazines, and a variety of reading materials. There is an outdoor activity area equipped for outdoor use. (87219). Miscellaneous: There is a first aid kit, including sterile dressings, bandages, thermometer, and other items as required by regulations. (87465). There are laundry supplies and equipment, including washing machine and dryer, and are in good repair. There is space for clean linen storage and a separate space for soiled linen. (87307). LPA Mixson observed emergency lighting supplies to include flashlights, and extra batteries, along with vehicles used to transport residents are operable and registered as stated by the administrator, (87303). Dementia Care: There were no bodies of water on the premises currently at the time of this visit, and there are auditory devices in place to monitor exits and completely enclosed outdoor activity space with self-closing latches and gates. (87705). Inside/Outside: All doors, and passageways are clear of obstruction. There were no bodies of water on the premises, and the fireplace was covered with a screen. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA Mixson observed central heating and air conditioning systems, and they are operable. The Administrators phone number was dialed, (619) 347-2140 and it was operable. Outside/Yards: Had shade and covering for shaded visits, and activities. There were no obstructions observed. The Licensee stated there were no firearms, and/or ammunition on the premises. CAB 8.0 Pre-licensing / COMP III Requested and is scheduled. An exit interview was conducted, a copy of this report was provided to the Administrator Malcolm White. There were no Title 22, Division 6 violations observed or cited on todays visit.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC809 (FAS) - (06/04)

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