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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413083
Report Date: 06/22/2023
Date Signed: 06/22/2023 07:25:08 PM

Document Has Been Signed on 06/22/2023 07:25 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:GEM'S SENIOR LIVING IIFACILITY NUMBER:
336413083
ADMINISTRATOR:GERLITA HIGAFACILITY TYPE:
740
ADDRESS:28291 PORTSMOUTH DRIVETELEPHONE:
(951) 301-4134
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY: 6CENSUS: 6DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
06:30 PM
MET WITH:ADMINISTRATOR, GERLITA HIGATIME COMPLETED:
07:30 PM
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On June 22, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, introduced self, and stated the purpose of the visit. LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story home located at 28291 Portsmouth Drive Sun City CA. 92586.
Physical Plant: The facility, is in good condition, neat, and orderly. Outdoor and indoor passageways were free of obstruction at the time of this visit. The restrooms were equipped with liquid soap and paper towels. LPA Mixson toured the kitchen and staff and residents were having diner. The facility had an activity schedule the Administrator will post and make available for review. The facility has emergency food and water. Smoke detectors are operable and show green light. The fire extinguisher was in the green. Carbon monoxide alarms, along with smoke detectors were observed. There was a locked and centralized storage area for medications. Medications are contained in bubble packs and bottles. The facility had a designated area for resident and staff files. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson reviewed two staff files two resident files, and conducted two staff interviews and two resident interviews. There were no regulation violations observed during todays visit.
An exit interview was conducted and a copy of this report was provided to Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2023
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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