<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336406714
Report Date: 12/14/2021
Date Signed: 12/14/2021 11:40:09 AM

Document Has Been Signed on 12/14/2021 11:40 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:RISING SUN HOMEFACILITY NUMBER:
336406714
ADMINISTRATOR:CONCHITA DIATAFACILITY TYPE:
740
ADDRESS:31-495 AVENIDA DEL PADRETELEPHONE:
(760) 770-1244
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 6CENSUS: 2DATE:
12/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Conchita Diata - Licensee/AdministratorTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Crystal Colvin conducted an unannounced visit to the facility for a case management visit, for the purpose of approving the facility's request for ambulatory status change. LPA met with Licensee/Administrator Conchita Diata, who assisted LPA Colvin with conducting a tour of the facility.

Per the LIC200, the Licensee submitted a request for allowance for one (1) bedridden resident. Facility is already approved for six (6) non-ambulatory residents. A representative from the Fire Marshal conducted a fire safety inspection on 12/2/21 and approved for the change in ambulatory status. During today’s visit, the LPA Colvin toured the facility and inspected the master bedroom, which was approved by the Fire Marshall for accommodating on non-ambulatory and one bedridden resident. LPA Colvin observed that bedroom #4 (which has been approved for bedridden by the Fire Marshal) is in good repair and had the required furniture and is complete with a ramp an exit door inside the bedroom leading to directly outside of the facility.

Licensee has also provided LPA Colvin with a Bedridden Care Plan which LPA Colvin will be adding to the facility's file. Facility has been approved for 1 bedridden resident as of today's date. LPA advised that she update the facility license and provide the Licensee with a new copy to reflect the change in ambulatory status next week. No deficiencies were cited during this visit.

An exit interview was conducted where this report was discussed and provided to Licensee/Administrator Conchita Diata.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1