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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600622
Report Date: 10/10/2024
Date Signed: 10/10/2024 03:45:40 PM

Document Has Been Signed on 10/10/2024 03:45 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:R N R HOMEFACILITY NUMBER:
198600622
ADMINISTRATOR/
DIRECTOR:		REICHENBERGER, REBECCAFACILITY TYPE:
735
ADDRESS:1619 SEKIO AVENUETELEPHONE:
(909) 594-6153
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY: 6CENSUS: 4DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:29 PM
MET WITH:Dolores Ugaban - Direct Support StaffTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA)s Mary Flores and Maya Cota conducted an unannounced annual visit at the facility using the CARE inspection tool. LPAs met with Dolores Ugaban and explained the reason for the visit. Administrator arrived 10 minutes later.

The facility is licensed to serve six (6) ambulatory Developmentally Disabled Adults ages 18-59 only. The facility is serving a level 2 home. Facility is a single home located in a residential area and consist of a living room, dining room, family room, kitchen, (3) client bedrooms, (1) bathroom, (1) staff bedroom, (1) staff bathroom, an attached garage/laundry, a front yard, and a backyard.

LPAs conducted a tour of the facility with Dolores Ugaban and observed the following;
Facility is in good repair inside and outside. Kitchen was observed clean, and sufficient food supplies were observed for at least 2 days of non-perishables and 7 days of perishables. Cleaning supplies and sharps are accessible to the clients as clients prepare own meals and daily activities. Living room and dining have furniture in good repair. Family room has a covered fireplace and furniture in good repair. Each client bedroom (3) has sufficient lighting, and the required bedding and furniture. Bathroom was observed in good repair and water temperature was tested 113.6 degrees F., which is within the required 105-120 degrees F. Garage/laundry area was observed in good repair and accessible to the clients in care. Smoke/Carbon Monoxide were tested and detector in room #2(R2) was slightly faint in sound. Backyard was observed to have a pergola to provide a seating shaded area. The left side of the home was observed to have a guava tree which has a slightly over grown branch. Fire extinguisher was observed and last checked on 12/27/18. No large bodies of water were observed.

LPAs reviewed medication, files, and P&I money for 4 clients and 4 staff files. Administrator certificate for Rebecca Reichenberger was observed #7002324735 exp. date: 9/10/25. (CONTINUED ON LIC 809C)
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: R N R HOME
FACILITY NUMBER: 198600622
VISIT DATE: 10/10/2024
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Emergency Disaster plans was observed, an Infection Control plan was not available for review. Last fire drill was conducted on 4/21/24 and have been conducted every 6 months.

No Deficiencies were noted during this visit. However, technical violations/advisories were provided.

Exit interview was conducted with Rebecca Reichenberger and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC809 (FAS) - (06/04)
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