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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425566
Report Date: 04/07/2021
Date Signed: 04/09/2021 07:47:11 AM

Document Has Been Signed on 04/09/2021 07:47 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:HOVLEY CARE LLCFACILITY NUMBER:
336425566
ADMINISTRATOR:SVETLANA CALAMAROFACILITY TYPE:
740
ADDRESS:40827 HOVLEY COURTTELEPHONE:
(760) 568-4100
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 6CENSUS: 3DATE:
04/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:06 AM
MET WITH:Svetlana CalamaroTIME COMPLETED:
08:20 AM
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Licensing Program Analyst (LPA), Stephanie Torres, contacted the facility via telephone call due to COVID-19 for the purpose of addressing a violation observed following the investigation of complaint #18-AS-20191016114807.

Records review revealed the facility has not provided proof of liability insurance from 09/01/2018 until this date, 04/07/2021. This posed a potential health and safety risk to the residents in care. A citation will be issued.

An exit interview was conducted with Calamaro, in which this report was reviewed and a copy was provided via email.
SUPERVISORS NAME: Reyna Lacey
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2021
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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Document Has Been Signed on 04/09/2021 07:47 AM - It Cannot Be Edited


Created By: Stephanie Torres On 04/07/2021 at 08:20 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HOVLEY CARE LLC
FACILITY NUMBER: 336425566

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2021
Section Cited
HSC
1569.605

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On and after 07/01/15, all RCFEs...shall maintain liability insurance covering injury to residents and guests in the amount of at least $1,000,000 per occurrence and $3,000,000 in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees.
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The licensee shall submit documentation of current and valid liability insurance. Proof will be submitted to the department by 04/14/21.
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This requirement is not met as evidenced by: Based on records review, the licensee failed to ensure that the facility had proof of liability insurance. The facility has not provided proof of liability insurance from 09/01/2018 until this date, 04/07/2021. This posed a potential health and safety risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Reyna Lacey
LICENSING EVALUATOR NAME:Stephanie Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2021


LIC809 (FAS) - (06/04)
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