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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601553
Report Date: 11/24/2021
Date Signed: 11/24/2021 03:08:16 PM

Document Has Been Signed on 11/24/2021 03:08 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CALIFORNIA MENTOR - MEADCLIFF HOMEFACILITY NUMBER:
198601553
ADMINISTRATOR:CHRIS SCHLANSERFACILITY TYPE:
734
ADDRESS:23612 MEADCLIFF PLACETELEPHONE:
(909) 274-7620
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 5CENSUS: 4DATE:
11/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Chris Schlanser, administratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Spencer conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Spencer met with administrator Chris Schlanser and discussed the purpose of today's visit. This single-story home contains five (5) bedrooms, two (2) bathrooms, a living room, kitchen, dining area, office, backyard, and attached garage.
The following was observed/inspected:
  • The facility had a universal entrance screening area; sign-in and temperature logs were maintained.
  • COVID-19 signage was placed in several areas of the facility including the front entrance.
  • All areas were found to be clean and in good repair.
  • Each room contained required furniture including bed, dresser, night stand, lamp, chair, and closet.
  • All beds contained the required linens including mattress cover, fitted sheet, flat sheet, blanket, and comforter.
  • Bathrooms contained supplies including liquid soap, toilet paper, and paper towels.
  • Facility maintained a 30-day supply of PPE to include masks, gowns, and face shields.
  • Staff wore face masks consistently throughout the shift and group activities were spaced to encourage physical distancing.
  • Smoke detectors/carbon monoxide detectors were present and operable.
  • A fire extinguisher was observed to be fully charged and last serviced in June 2021.
  • Client files, staff files, and medications were not inspected during this time.
  • Due to time constraints, the visit was discontinued.


There were no deficiencies cited at this time. An exit interview was conducted and a copy of this report was provided to the administrator.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: LaJean Nicole Spencer
LICENSING EVALUATOR SIGNATURE: DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2021
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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