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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408381
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:53:45 PM

Document Has Been Signed on 04/18/2023 02:53 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:ST. MARY'S LOVE AND CARE HOMEFACILITY NUMBER:
336408381
ADMINISTRATOR:JANARD LANSANGANFACILITY TYPE:
740
ADDRESS:74039 KOKOPELLI CIRCLETELEPHONE:
(760) 779-9887
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 6CENSUS: 5DATE:
04/18/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Philip Christian, AdministratorTIME COMPLETED:
03:05 PM
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On 4/18/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to continue the annual inspection visit started on March 29, 2023. LPA Nwogene was greeted and granted entry by caregiver, Elsa Hayagan. LPA also met with Administrator, Philip Christian who was informed of the purpose of visit. At the time of visit there was 3 staff and 5 residents present. During the annual inspection on March 29, 2023, LPA toured the facility inside and out with Administrator, Philip Christian and Caregiver, Charito Bernardo.

Tour included:

Kitchen; LPA toured the kitchen and observed kitchen to be clean and food stored in a safe and healthful manner. Utensils and dishware are sufficient for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen drawer, available only to authorized individuals. Trash cans has tight-fitting lid. Dishwasher is used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 35 degrees Fahrenheit and Freezer was measures at 0 degrees Fahrenheit.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 75 degrees Fahrenheit.

Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medications; LPA observed medications were labeled and stored in separate bins inside of a locked medication cabinet and are distributed according to physician orders. The first aid kit was complete.

Continue on LIC809-C

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ST. MARY'S LOVE AND CARE HOME
FACILITY NUMBER: 336408381
VISIT DATE: 04/18/2023
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Continued from LIC809

Bathroom; LPA toured the two full and a half bathrooms and observed bathrooms to be clean and equipped with grab bar and nonslip mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 116 degrees Fahrenheit.

Bedroom; LPA toured five #5 out of #5 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility.

Garage; LPA tour the garage and observed garage to be clean and not cluttered.

Laundry; LPA toured the laundry and observed laundry to be clean. Washing machine and dryer are all in good repair. Cleaning supplies are stored away in the laundry room, inaccessible to clients.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. Facility has a pool. LPA observed pool to be adequately secured.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents.

Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Random staff and residents' records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 4/21/2024.

Interview; Three #3 staff and two #2 residents present were interviewed.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Philip Christian.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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