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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881587
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:48:59 PM

Document Has Been Signed on 08/21/2024 01:48 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SUNSET LAMTARRA LOOPFACILITY NUMBER:
331881587
ADMINISTRATOR/
DIRECTOR:		UATA, THOMASFACILITY TYPE:
740
ADDRESS:32999 LAMTARRA LOOPTELEPHONE:
(951) 746-2398
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 6CENSUS: 0DATE:
08/21/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Applicant,Thomas UataTIME VISIT/
INSPECTION COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an announced visit to conduct a prelicensing inspection for an initial application. LPA met with Applicant, Thomas Uata.

The applicant is seeking an initial application for a residential care facility for the elderly. The facility is a one story home, with attached garage, (3) bathrooms and (4) bedrooms. There are no bodies of water or firearms at the facility. The fire clearance was approved for (6) non-ambulatory residents and hospice waiver for (6).

LPA conducted a tour of the interior and exterior of the facility. LPA observed cleaning supplies, hygiene supplies, and PPE supplies. LPA observed locked areas where sharps and medications are being stored and locked. The carbon monoxide alarm was functional during the time of the visit. First aide kit was observed and ordered emergency supplies. The facility had required amounts of food items and the kitchen was observed to be clean and in good repair with items to cook and prepare food. Telephone service is operation at (951) 746-2398. Laundry equipment was observed during the time of the visit and was operational. Furniture and linens were present and in good repair. Hot water temperature was recorded at 105F. The facility exits were observed to be accessible and free of obstructions.

The applicant may proceed in the prelicensing process. No health or safety concerns were observed during the time of the visit. An exit interview was conducted where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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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