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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423672
Report Date: 10/16/2024
Date Signed: 10/16/2024 12:11:01 PM

Document Has Been Signed on 10/16/2024 12:11 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:DESERT COTTAGE IIFACILITY NUMBER:
336423672
ADMINISTRATOR/
DIRECTOR:
ELIZABETH HENGSTLERFACILITY TYPE:
740
ADDRESS:83-421 MATADOR COURTTELEPHONE:
(760) 342-7767
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY: 6CENSUS: 1DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Elizabeth HengstlerTIME VISIT/
INSPECTION COMPLETED:
12:19 PM
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Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs were greeted by licensee Elizabeth Hengstler, notified her of the purpose for the visit and were allowed to enter the facility to conduct the inspection.

Facility Overview: The facility is a single story building with 4 bedrooms and 3 bathrooms. There is no gated pool and there are no firearms on the premises.

Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements.

Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in kitchen cabinet and inaccessible to residents. The smoke detector and carbon monoxide detector were tested and were operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with and expiration date of 12/2025. LPAs observed the hot water temperature to meet requirements at 109.1°F.

Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of December 25th, 2024.


Continued on LIC809-C.....
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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: DESERT COTTAGE II
FACILITY NUMBER: 336423672
VISIT DATE: 10/16/2024
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Record Review and Resident/Staff Files: LPAs reviewed files for three staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. One resident's file was reviewed and contained all required documentation. LPA's observed Staff, resident files, first aid kit were locked in a cabinet in the kitchen, and PPE's, emergency food and water were stored in the garage.

Health-Related Services/Incidental Medical Services: All residents' medications were securely locked located in the kitchen cabinets..

Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 7-1-2024, which met department requirements. All facility exits were clear of obstructions.



No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Elizabeth Hengstler
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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