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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881584
Report Date: 08/30/2024
Date Signed: 08/30/2024 03:51:17 PM

Document Has Been Signed on 08/30/2024 03:51 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:ROUDEL'S PLACEFACILITY NUMBER:
331881584
ADMINISTRATOR/
DIRECTOR:		PIANO, CECILE SFACILITY TYPE:
740
ADDRESS:46243 ROUDEL LANETELEPHONE:
(760) 238-0409
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY: 6CENSUS: 0DATE:
08/30/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Cecile Piano, Licensee/Administrator & Lizajane Cortez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 2:30 PM, LPA met with Licensee/Administrator Cecile Piano. An initial application to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 1/16/2024 for a total capacity of six (6) non-ambulatory and zero (0) bedridden residents. Fire clearance was granted on 04/18/2024. LPA Delgado observed the following:
Structure:
Facility was a one-story house with five (5) resident bedrooms, two and half (2.5) resident bathrooms, living room, dining area and kitchen. Two (2) caregiver rooms on the east side of the home. There was an attached two car garage in the front of the house.
Heating/Cooling System:
Central heating and air conditioning system installed with two central panel located in the hallway to control each side of the house.
Bedrooms:
Each resident bedroom #1, #2, #3 and #4 will accommodate any private non-ambulatory resident, bedroom #5 shared will accommodate two non-ambulatory residents. 5 resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm.
Bathrooms:
The two and half (2.5) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 3:00 PM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 130.3 degrees Fahrenheit with warning labels posted.

(CONTINUED ON LIC 809C)
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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: ROUDEL'S PLACE
FACILITY NUMBER: 331881584
VISIT DATE: 08/30/2024
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(CONTINUED FROM LIC 809)
Kitchen/Laundry:
An adequate supply of dishes, glasses, utensils, pots and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the home. Laundry detergents and cleaning supplies were observed in locked cabinet away from residents.
Living/Family room:
There was a living/family room with seating for all clients and working TV with internet access.
Linens and Hygiene Supplies:
An adequate supply of linens was stored in a cabinet in the main hallway of the home and hygiene supplies stored under the bathroom sinks.
Yards/Outside:
Patio table and six chairs were observed in the backyard. There was a gate on the South side of the property with a self-latching lock. All outdoor pathways were free of obstructions.
Emergency Phone Numbers, and Exit Plan:
Facility sketch were observed posted in the main hallway. Obudsman poster and Let-Us-No poster observed.
General items:
Three (3) fire extinguishers were charged and located in the kitchen, hallway ad entrance. Nine (9) dual smoke/carbon monoxide alarm detectors were tested and were observed to be in working order. Client records will be stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water and food supply was observed. LPA did not observed any bodies of water and no fire arms will be stored at the home. Component III was completed on August 20. 2024 at the Riverside RO.

Pre-Licensing is complete.

An exit interview was conducted with Cecile Piano, Licensee/Administrator & Lizajane Cortez, Licensee and a copy of this report was given.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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