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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412126
Report Date: 05/20/2021
Date Signed: 05/20/2021 11:44:56 AM

Document Has Been Signed on 05/20/2021 11:44 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:INSPIRATIONS HOME CARE VFACILITY NUMBER:
336412126
ADMINISTRATOR:GARCIA, NOELIAFACILITY TYPE:
740
ADDRESS:2865 COTTAGE DRTELEPHONE:
(951) 898-1425
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 6CENSUS: 6DATE:
05/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Noelia GarciaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Pauline Beschorner arrived at the facility on May 20, 2021 at 11:05 AM to conduct an Annual/Required Visit. Upon LPA arrival, caregiver Noel Malixi greeted LPA at the door and LPA's temperature was checked and LPA signed in. Licensee Noelia Garcia accompanied LPA on a tour of the inside and outside of the facility and the following was observed:

All staff and residents have been vaccinated. All staff are wearing a surgical mask while working at the facility. Garcia stated that she keeps the line list of employees in her office but all staff are tested for COVID at least monthly. Garcia sends 25% of her staff weekly.

LPA observed all COVID signs present including hand washing, donning and doffing of PPE, visitation policy and cough etiquette. LPA observed 2 residents in the living room sitting at least 6 feet from each other watching television.

LPA observed all residents have an outside entrance door so that visitors do not need to enter into the facility and walk through the house. Visitors are screened at the front door and walked outdoors, by a caregiver to the entrance of the residents room.

The facility provides care to residents with dementia but the facility does not have a designated memory care ward.

An exit interview was conducted and a copy of this report was provided to Licensee Noelia Garcia. No citations or technical violations are being issued at this time.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Pauline Beschorner
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2021
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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