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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336401433
Report Date: 02/10/2022
Date Signed: 02/10/2022 01:32:01 PM

Document Has Been Signed on 02/10/2022 01:32 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:REAL SWEET HOMEFACILITY NUMBER:
336401433
ADMINISTRATOR:DIAZ, FEDELIAFACILITY TYPE:
740
ADDRESS:20905 EL NIDOTELEPHONE:
(951) 943-8762
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 6CENSUS: 5DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Licensee, Fedelia DaizTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) David Cuevas made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by licensee/administrator, Fedelia Daiz, who was explained the purpose of the visit. At the time of visit there was 2 staff and 5 residents present. The facility currently has zero positive or suspected Covid-19 cases. LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home.

During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer) in restroom.

At the time of visit Licensee, stated that a mitigation plan was develop; however, Licensee was unable to present to LPA and stated that it would be sent to LPA via email for review by 2/14/22 5PM. Per Licensee, the facility will contact the resident's physician should there be event of any COVID-19 related illnesses. The facility also has a designated infection control lead and cleans and disinfects the highly touched surfaces during each shift, and as needed.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to licensee/administrator, Fedelia Daiz.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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