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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881590
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:28:45 PM

Document Has Been Signed on 12/16/2024 02:28 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:SHADOWRIDGE SENIOR LIVINGFACILITY NUMBER:
371881590
ADMINISTRATOR/
DIRECTOR:		FUHRMAN, MICHELEFACILITY TYPE:
740
ADDRESS:2354 WATSON WAYTELEPHONE:
(760) 295-3888
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 48CENSUS: 0DATE:
12/16/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Administrator Michele FuhrmanTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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Licensing Program Analyst, (LPA) Armando Perez made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA met with Administrator Michele Fuhrman, who accompanied LPA for the inspection. Applicant has submitted an application for forty eight (48) ambulatory residents. On December 6, 2024, Vista Fire Department approved a fire clearance for the facility.

The facility is a two story facility with 20 client bedrooms, living room, dining area, kitchen, and activities room. LPA observed clients’ bedrooms with the required bedding and furniture, such as, clean mattresses/linen, night stands, dressers, chairs, lighting, and emergency lighting. Client bathrooms and showers had clean appliances that were operating in safe and sanitary condition and had the grab bars in toilets and showers. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. The facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Sharps, such as knives and scissors, will be stored in the kitchen with the entrance to the kitchen be locked and not accessible to clients.

LPA observed an adjacent structure that is currently under construction. According to administrator, additional rooms will be added. The floor plan will need to be updated to include the structure and fire clearance will need to reflect the approved number of clients when completed. Due to construction, the water heater and laundry has been temporarily relocated in the back yard in an enclosed shed. LPA inspected the water temperature and observed the temperature at 103.4.

Client and personnel files will be in a locked closet in the administrators office on the first floor. Client medication will be centrally stored and locked in a designated room on the first floor. The facility has no pool or any bodies of water. There is a covered patio area with seating for all the clients. All passageways were free from obstruction. LPA observed fire extinguishers in the facility with the last service date of March 28, 2024. The smoke detectors and carbon monoxide alarms were operational and recently tested by Vista Fire Department.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: SHADOWRIDGE SENIOR LIVING
FACILITY NUMBER: 371881590
VISIT DATE: 12/16/2024
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The facility does not have any known firearms and ammunition on the property. LPA observed the required postings of the emergency disaster plan, resident personal rights, complaint procedures, employee rights, visitation rights, facility sketch, and the Long-Term Care Ombudsman poster. Facility contains emergency supplies and first aid kits with the required items. The facility has working telephone for client use. LPA observed Applicant's Administrator Certification on file with expiration date of 10/13/2026.

LPA observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. LPA determined the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete and this facility has no issues or concerns. Once construction is completed and updated floor plan and fire clerance will need to be submitted before accepting clients into that structure. The facility has satisfied all requirements in accordance with Title 22, California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Administrator Michele Fuhrman.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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