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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409083
Report Date: 12/30/2024
Date Signed: 12/30/2024 01:34:13 PM

Document Has Been Signed on 12/30/2024 01:34 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:VANDELON HOMECARE, INC.FACILITY NUMBER:
336409083
ADMINISTRATOR/
DIRECTOR:		MARLON UYFACILITY TYPE:
740
ADDRESS:1335 E. WHITTIER AVETELEPHONE:
(951) 791-0061
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY: 6CENSUS: 4DATE:
12/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Maribeth Dayrit, House ManagerTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the home. The LPA was allowed entrance into the facility and met with House Manager, Maribeth Dayrit. The LPA informed Dayrit of the purpose for the visit, who later notified Administrator, Marlon Uy, via telephone. 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 Manager Dayrit, modified diets are being provided to residents in care. Manager Dayrit reported the staff members on shift who engage in food preparation and services observe personal hygiene and food services sanitation practices.

Physical Plant: The facility consists of five (5) resident bedrooms, four (4) bathrooms, a kitchen and dinning area, a living room area, a staff room, storage spaces and a yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to Manager Dayrit, no weapons are stored at the facility. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways were kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet and shower used by residents. Resident showers have slip resistant mats present. The hot water temperature was tested and observed to be within regulatory requirements. One smoke detector and one carbon monoxide device were tested by staff and were observed to be in operating condition. The facility was kept clean, organized and free of any odors.

Record Review: All staff were observed to have appropriate fingerprint clearances. LPA did not observe any
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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: VANDELON HOMECARE, INC.
FACILITY NUMBER: 336409083
VISIT DATE: 12/30/2024
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excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid and CPR training. Training on dementia care, postural supports, restricted health conditions, hospice and medication administration was observed on file; though incomplete. Resident files had admission agreements, medical assessments, appraisal/needs and services plans, and other required records on file. The licensee appears to be operating the facility within the conditions specified on the license. The facility currently has an approved Hospice Waiver for four (4) residents; and there are currently four (4) residents in care receiving hospice services. There is an emergency disaster plan in place. Proof of emergency drills was observed on file. The licensee (Vandelon Home Care Inc.) is a current and active corporation. The LPA observed current liability insurance on file.

Medication Review: The LPA inspected resident medications. Medications were observed to be well organize and inaccessible to unauthorized individuals. Centrally stored medication destruction records were observed on file.

Manager Dayrit agreed to provide the LPA with a copy of the current liability insurance, staff schedule, and resident roster.

An exit interview was conducted with Manager Dayrit, in which this report was reviewed, and a copy was provided. No citations were issued at time of inspection.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC809 (FAS) - (06/04)
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