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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424427
Report Date: 01/22/2025
Date Signed: 01/22/2025 02:27:38 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/22/2025 02:27 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LAMA RESIDENTIAL CAREFACILITY NUMBER:
336424427
ADMINISTRATOR/
DIRECTOR:
HILARIA BRIZANFACILITY TYPE:
740
ADDRESS:14384 POINTER LOOPTELEPHONE:
(951) 582-9044
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 6CENSUS: 0DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Administrator Hilaria BrizanTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Raquel Hernandez made an announced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Hilaria Brizan

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for a capacity of six (6) non-ambulatory residents. The current census is zero (0) residents. LPA was accompanied by Administrator Hilaria Brizan to conduct a general overall inspection, which included, but was not limited to, the following:



There are no obstructions to interior and exterior passageways. The facility is maintained at a comfortable temperature at 68 degrees. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. The postings such as the facility license, personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. The cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to future residents in care. There was a designated storage space for future resident files and staff files. The medications will be stored in a locked cabinet located in pantry.

The facility does not have residents files to review. LPA reviewed one (1) staff file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Administrator Hilaria Brizan.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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