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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426762
Report Date: 01/29/2024
Date Signed: 01/29/2024 11:09:23 AM

Document Has Been Signed on 01/29/2024 11:09 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
, CA 92507
FACILITY NAME:HIGHLAND SENIOR HOME CARE LLCFACILITY NUMBER:
366426762
ADMINISTRATOR:LIWANAG, AMPAROFACILITY TYPE:
740
ADDRESS:7513 SWEETMEADOW COURTTELEPHONE:
(909) 714-0225
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 6CENSUS: 5DATE:
01/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Pat Salinas, care staff TIME COMPLETED:
11:11 AM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility as a proof of correction visit for deficiencies issued during the facility's recent annual inspection on 01/19/24. LPA met with care provider Pat Salinas who was informed of the reason for the visit.

During today's visit, LPA spoke with Resident and observed them use their half rail for mobility. LPA reviewed emergency and disaster training and log. LPA observed care staff training manual and hospice care training logs. LPA phoned Licensee to remind them that hospice care training should reflect the hospice care plan. Letters of Deficiency Citation Cleared were issued today.

No deficiency was issued during today's visit. An exit interview was conducted where this report was discussed with Ms. Salinas.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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