Eastvale Meadows

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Hernandez met with Administrator Brooke Simm. The capacity is (6) current census is (5). The facility is a five (5) bedroom, three (3) bathroom home with a kitchen/dining area, living room and attached garage. The facility is Residential Care Facility for the Elderly (RCFE). LPA Hernandez was accompanied by Administrator Brooke Simm to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA Hernandez 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 Hernandez observed sufficient furniture and lighting throughout the facility. The hot water temperature tested at 108 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet with the resident’s medications locked. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has sufficient number of staff to provide care and supervision to the residents in care. **Continuation on LIC809-C** Record Review: LPA Hernandez reviewed three (3) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed three (3) residents medications. LPA Hernandez reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with Tuberculosis (TB) test result. No issues were observed 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 Brooke Simm.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Administrator Brooke Simm and was granted entry to the facility. Licensed capacity is (6) current census (5). LPA was accompanied by Administrator Brooke Simm to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature at 76 degrees. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed Resident #1 (R1) to be bedridden. Facility is not licensed for bedridden residents. Deficiency will be issued. Hot water temperature tested within regulation at 113 degrees Farenheit. LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated space for resident/staff files. First aid book and first aid kit were observed. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed (4) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA observed no appraisal for all residents needs and services plan. Deficiency will be issued. LPA reviewed (4) resident medications. LPA observed no PRN medication record for Resident #2 (R2). R2 has not taken any of prescribed PRN medication, however, LPA recommended to print a Medication Administration Record (MAR) for R2 when needed. Technical Assistance was issued. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. No issues observed. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC809C) (LIC809D) and Appeal Rights was discussed and provided to Administrator Brooke Simm.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Caregiver Amelia Rodriguez and was granted entry to the facility. 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 six (6) residents. LPA was accompanied by Caregiver to conduct a general overall inspection, which included, but was not limited to, the following: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to interior and exterior passageways. The facility provides care to residents with dementia which requires auditory alarms on the facility exit doors. The facility will be issued a deficiency for not having an auditory alarm on the facility exit door in resident bedroom number one (1). The facility is maintained at a comfortable temperature. 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. LPA measured and observed the water temperature in the bathroom to be at 112.4 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Postings such as the facility license, personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident and staff files. Medications are kept inside the kitchen inaccessible to residents. LPA found that Resident’s R1, R3, R6, and an unknown resident’s medications were being stored in plastic storage containers. The facility will be issued a deficiency for not storing the resident’s medications in the original medication containers. LPA found that the bathroom closet is being used for sleeping arrangements for the facility staff. The bathroom closet contains a bed, a nightstand, and sleeping arrangements for the facility staff. The facility will be issued a deficiency for converting the bathroom closet into a sleeping area for the staff. Food Service: Non-perishable and perishable food supply is sufficient for the residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. Record Review: LPA reviewed six (6) residents files for admission agreements, updated physician reports, and needs and services plans. LPA found that Resident R5 does not have physician’s report/medical assessment completed. The physician’s report/medical assessment in R5’s file was blank and not completed by a physician. The facility will be issued a deficiency for not having a physician’s report/medical assessment completed for R5. LPA found that Resident’s R1, R3, and R4 have a qualifying condition that requires an annual physician’s report/medical assessment. Resident R1’s most recent physician’s report/medical assessment was completed on 11/15/2022, Resident R3’s most recent physician’s report/medical assessment was completed on 1/16/2020, and Resident R4’s most recent physician’s report/medical assessment was completed on 12/5/2022. The facility will be issued a deficiency for not having an annual physician’s report/medical assessment was completed for R1, R3, and R4. LPA found that Resident’s R1, R2, R3, R4, and R5 do not have a needs and services plan completed. The facility will be issued a deficiency for not having needs and services plan completed for Resident’s R1, R2, R3, R4, and R5. LPA reviewed three (3) staff files for First Aid/CPR certifications, criminal record clearances, trainings, and health screenings. Based on the observations made during today’s visit, six (6) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and LIC811 were discussed and provided to Caregiver Amelia Rodriguez, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Dec 8, 2023