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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881597
Report Date: 12/24/2024
Date Signed: 12/24/2024 11:07:44 AM

Document Has Been Signed on 12/24/2024 11:07 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SWEET JORLENE HOMECAREFACILITY NUMBER:
331881597
ADMINISTRATOR/
DIRECTOR:		NUGUID, SUSAN LFACILITY TYPE:
740
ADDRESS:30875 AVENIDA JUAREZTELEPHONE:
7147100587
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 6CENSUS: 0DATE:
12/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Susan L. Nuguid, applicantTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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On 12-24-2024 Licensing Program Analyst (LPA) Seo Jeon made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Applicant, Susan L. Nuguid, who accompanied LPA for the inspection. The Applicant has submitted an application for 6 residents (5 non-ambulatory and 1 bedridden). On 5-9-2024, the Riverside County Fire Department approved a fire clearance for which the applicant has applied for. The bedroom #6 is specifically for a bedridden resident and the rest are for non-ambulatory residents.

The home is a single story structure consisting of 6 bedrooms, 6 bathrooms, kitchen, formal dining room, garage, backyard with a covered patio, and a locked shed that is being used for storage. The bedrooms were observed to have bed, lighting, night stand, chest of drawers and area for sitting. The bathrooms had nonskid mats, and grab bars. There is plenty of extra linen (sheets, blankets, towels) that were observed to be in good repair. The smoke and carbon monoxide detectors were tested and found to be operable.

The hot water temperature was tested and was found to be within regulatory limits measuring at 106 degrees Fahrenheit. The facility is equipped with flashlights and night lights. The facility has an emergency disaster plan, and infection control plan on file. The facility has a sufficient supply of dishes, cooking and eating utensils, that were observed to be in good repair. The facility food supply was observed to be sufficient as there were 2-day supply of perishable and a 7-day supply of nonperishable food items. The facility has an emergency food and water supply. There is a fully stocked first aid kit with manual.

Continued on LIC809-C....
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/24/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SWEET JORLENE HOMECARE
FACILITY NUMBER: 331881597
VISIT DATE: 12/24/2024
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The passageways, and ramps/inclines are clear and free from obstruction. The home has 1 fully charged fire extinguisher. The facility does not have any known guns or ammunition stored on grounds. The sharps/knives are stored in a locked drawer. The medications will be kept in individual boxes that will be stored in a locked cabinet located next to kitchen area.

Wall in the kitchen area has the required postings (facility sketch, resident council, theft and loss policy, personal rights, PUB475 CCL/dept complaint poster and Long Term Care Ombudsman poster.

The facility was observed to have activities to encourage socialization such as, Monopoly and Scrabble, as well as a covered patio with plenty of outdoor space for walking and physical activities.

The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted and a copy of this report was provided to applicant Susan L. Nuguid.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC809 (FAS) - (06/04)
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