330911397-2-20-2025-18-AS-JARA-DE3UJN-20250220143748

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330911397
Report Date: 02/20/2025
Date Signed: 02/20/2025 02:38:11 PM

Document Has Been Signed on 02/20/2025 02:38 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:	BETA RESIDENTIAL HOME		FACILITY NUMBER:	330911397
ADMINISTRATOR/ DIRECTOR:	MARTIN, MARY		FACILITY TYPE:	735
ADDRESS:	12035 HINSON STREET		TELEPHONE:	(951) 243-1911
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY: 4		CENSUS: 2	DATE:	02/20/2025
TYPE OF VISIT:	POC	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:37 PM
MET WITH:	Staff, Bonifacio Carlos		TIME VISIT/ INSPECTION COMPLETED:	02:40 PM

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Licensing Program Analysts (LPA)’s Janira Arreola and Armando Perez, conducted an unannounced visit to the facility to conduct a Plan of Correction (POC) Visit. The purpose of this report is to document the POCs that were previously agreed upon. LPAs met with Staff, Bonifacio Carlos, who was informed of the purpose of the visit. LPAs conducted a walk through, records review and interviews.

At the time of the visit there were (2) staff and (2) clients present. No immediate health or safety issues were observed.

The following deficiency were not corrected by the POC due date nor at the time of the visit. Civil Penalties are being assessed and will continue to accrue until correction has been submitted:

A deficiency was cited for 87303(a) for facility pool with green opaque water half way full. The POC was to clean the pool and send proof by the POC due date of 02/14/2025.

A deficiency was cited for 80036(a) for outstanding fee balance of $681.00 that was due 02/14/2025. The licensee stated they would pay the outstanding the balance and send proof by the POC due date of 02/14/2025.

A deficiency was cited for 85064(b) for not having a certified administrator, the licensee agreed to submit their renewal for Administrator’s certificate and designate a qualified administrator to the facility by the PoC due date of 2/14/2025.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BETA RESIDENTIAL HOME	FACILITY NUMBER: 330911397
	VISIT DATE: 02/20/2025

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A deficiency was cited for 80063(a)(1) for not having an active governing body, as Community Valley Homes INC. is in a stated of forfeiture with the Franchise Tax Bureau (FTB). The licensee agreed to submit documentation showing good standing with the FTB by the POC due date of 02/14/2025.

On today’s date LPAs met with Staff who stated they were unaware of the above plans of corrections were met. Staff stated they were not informed if someone was coming to clean the pool. During the visit LPAs observed the pool is in the same state and had not been cleaned or emptied. No POCs have been received by the LPAs to date. LPAs contacted Licensee Mary Martin who stated she was working on getting the items worked by tomorrow 2/21/2025, and work on getting proof of the other corrections as soon as possible. Therefore the POCs has not been met.

Civil penalties are being assessed for the fees, the incorporation and the governing body for the dates of 02/15/2025 to 02/20/2025 in the amount of $100 per day for 6 days. Civil penalties were assessed for the pool clean up for repeated violation at $250. The staff was advised civil penalties will continue to accrue until the POC is submitted. An exit interview was conducted where this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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