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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881615
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:29:13 PM

Document Has Been Signed on 10/08/2024 03:29 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:ARIANNE'S SENIOR CAREFACILITY NUMBER:
331881615
ADMINISTRATOR/
DIRECTOR:
COLLERA, JENNIFER EFACILITY TYPE:
740
ADDRESS:45010 DESERT FOX DRIVETELEPHONE:
(909) 358-9966
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY: 6CENSUS: 0DATE:
10/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Jennifer ColleraTIME VISIT/
INSPECTION COMPLETED:
03:36 PM
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Licensing Program Analysts (LPAs) Armando Perez and Ferrer Sabarias made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Applicant, Jennifer Collera, who accompanied LPAs for the inspection. The Applicant has submitted an application for six (6) residents. On 8-13-2024 the Riverside County Fire Department approved a fire clearance for 2 ambulatory and four non ambulatory residents.

Facility is a one-story building with 4 bedrooms, 3 bathrooms, laundry room, living room, dining area, kitchen and attached garage. LPAs observed clients’ bedrooms with the required bedding and furniture, such as, clean mattresses/linen, night stands, dressers, chairs, lighting, and emergency lighting. Client bathrooms had clean appliances that were operating in safe and sanitary condition and the showers contained non-slip surface. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Water temperature in the kitchen and bathrooms measured within regulation at 115.4 degrees F.

Client and staff files will be in locked in the living room cabinet. Client medication will be centrally stored and locked in the kitchen cabinet. The facility has a pool with the locked fencing requirements. There is a covered patio area with seating for all the clients. All passageways were free from obstruction. LPAs observed a fire extinguishers in the facility with the last service date of 08/13/24. The smoke detectors and carbon monoxide alarms were operational. The facility does not have any known firearms and ammunition on the property. LPAs observed the required postings of the emergency disaster plan, resident personal rights, complaint procedures, employee rights, visitation rights, facility sketch, and the Long-Term Care Ombudsman poster. Facility contains emergency supplies and first aid kits with the required items. The facility has working telephone for client use.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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: ARIANNE'S SENIOR CARE
FACILITY NUMBER: 331881615
VISIT DATE: 10/08/2024
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LPAs observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. The applicant has an appointment to complete COMP III orientation on 10-16-2024 and is in the pending process for the administration certificate. LPAs determined the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to applicant Jennifer Collera.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024
LIC809 (FAS) - (06/04)
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