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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336405884
Report Date: 11/22/2024
Date Signed: 11/22/2024 04:02:20 PM

Document Has Been Signed on 11/22/2024 04:02 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:INTEGRATED CARE COMMUNITIES - A1FACILITY NUMBER:
336405884
ADMINISTRATOR/
DIRECTOR:
EMELY C. RODRIGUEZFACILITY TYPE:
740
ADDRESS:14265 NASON STREETTELEPHONE:
(951) 601-9100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 22CENSUS: 19DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Kristin Hernandez, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the facility. The LPA was allowed entrance into the facility and met with Assistant Manager, Kristin Hernandez. The LPA informed Hernandez of the purpose for the visit. The inspection included the following:

Food Service: The LPA inspected the facility's kitchen areas and food supply. The LPA observed all food to be of good quality. All readily perishable foods and beverages capable of supporting rapid and progressive growth of micro-organisms were stored in covered containers at appropriate temperatures. Soaps, detergents, cleaning compounds and similar substances were stored in areas separate from food supplies. All kitchen areas were kept clean and free of litter, rodents, vermin, and insects. According to Assistant Manager Hernandez, modified diets are being provided to residents in care. An interview was conducted with the staff member on shift who is engaged in food preparation and services. The staff member reported personal hygiene and food services sanitation practices are being observed.

Due to insufficient time, another visit will be completed to continue the annual inspection. This report was reviewed and Assistant Manager Hernandez and a copy was provided.

NOTE: Administrator, Emely Rodriguez, was not available during the LPA's visit.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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