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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881566
Report Date: 09/18/2024
Date Signed: 09/18/2024 11:45:03 AM

Document Has Been Signed on 09/18/2024 11:45 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ADDING A TOUCH OF LOVE ELDERLY CARE FACILITYFACILITY NUMBER:
331881566
ADMINISTRATOR/
DIRECTOR:		PINTO, LEAHFACILITY TYPE:
740
ADDRESS:19716 SEASON GROVETELEPHONE:
(951) 532-1596
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY: 6CENSUS: 0DATE:
09/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:ADMINISTRATOR, TIMOTHY WILLIAMSTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On September 18, 2024, Licensing Program Analysts (LPAs), Venus Mixson and Armondo Perez arrived for a scheduled visit for the purpose of conducting the Pre-Licensing visit. LPAs met with the Administrator, Timothy Williams introduced themselves, and stated the purpose of the visit.

Physical Plant: The location is a single-story home located at 19716 Season Grove Riverside, CA. 92507 and has four bedrooms, two full bathrooms, a living room, dining room, and a kitchen, with a two-car garage.
A backyard and front yard. The Riverside County Fire Department approved this facility for five non-Ambulatory, zero-Ambulatory, and one bedridden resident, on August 14, 2024. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate, for Timothy Williams, is current with an expiration date of 04/17/2026.

Medications: LPAs observed where medications are to be stored, locked, and inaccessible to the residents in care. 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.
LPAs observed the fire extinguisher, it was charged and in the green, and serviced on 08/24/2024. The cleaning supplies were locked and inaccessible, along with the sharp objects and the Administrator informed the LPAs there are no firearms, or weapons on the premises.

Bedrooms: The bedrooms were large enough to allow for easy passage between the beds, and other required items of furniture will be present prior to receiving resident.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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: ADDING A TOUCH OF LOVE ELDERLY CARE FACILITY
FACILITY NUMBER: 331881566
VISIT DATE: 09/18/2024
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Kitchen/Food: The knives and sharps were locked and stored in the garage, pots, pans, and other kitchen accessories will be available prior to receiving residents. The facility shall have the the required seven-day supply of non-perishable food items and the two-day supply of perishable food items prior to receiving residents. LPAs were informed the the Administrator that hygiene supplies for residents shall be available prior to receiving 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).
Records: There is confidential storage space for personnel records at the time of this visit and it is lockable. (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: LPAs were informed by Administrator that non- emergency telephone numbers shall be posted prior to receiving resident. LPAs observed
Personal Rights, Complaint Poster, and other required documents 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 in the language of choice. 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 machine in good repair, and there is space for clean linen storage and a separate space for soiled linen. (87307). LPAs observed emergency lighting supplies to include flashlights, and extra batteries. (87303).
Inside/Outside: All doors, and passageways are clear of obstruction. There were no bodies of water on the premises, and no fireplace. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA's observed central heating and air conditioning systems, and they are operable. The Administrator dialed the land line phone number (951) 213-2258, and it was operable.
CAB 8.0 Pre-licensing / COMP III Requested and is scheduled. An exit interview was conducted, a copy of this report was discussed and given to Administrator, Timothy Williams.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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