<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800090
Report Date: 09/21/2023
Date Signed: 09/21/2023 02:36:28 PM

Document Has Been Signed on 09/21/2023 02:36 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:UNLIMITED QUEST INC - SUNNYMEADFACILITY NUMBER:
331800090
ADMINISTRATOR:HARRIS, FRENAFACILITY TYPE:
775
ADDRESS:14325 FREDERICK STTELEPHONE:
(909) 483-2505
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 75CENSUS: 50DATE:
09/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Day Program Manager, Candace SmithTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/21/2023, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct a required annual inspection. LPA met with Day Program Manager, Candace Smith who was informed of the purpose of the visit. During the visit, there was 19 clients and seven (7) staff present, and LPA was informed that two (2) staff and six (6) clients were out in the community.

LPA toured the facility’s interior and exterior with Day Program Manager Smith. The facility serves adults ages 18 through 59 and has an approved capacity for 75 non-ambulatory clients. The facility is made up of nine (9) classrooms, six (6) bathrooms, four (4) storage rooms, three (3) staff offices, a conference room, kitchen/dining room and multipurpose room. LPA toured the kitchen and observed the kitchen area to be clean. Snacks are provided to clients during program hours. Restrooms were clean and had toilet paper, paper towels and soap readily available for clients. The hot water temperature in three (3) bathrooms measured at 111- , 114- and 116-degrees Fahrenheit. Cleaning solutions/supplies and chemicals were secured in storage closets, inaccessible to clients. Client medication is typically secured in a cabinet stored in a staff office; however, LPA was informed that the facility does not have any clients who currently require medication assistance during program hours.

Continued on LIC809-C.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: UNLIMITED QUEST INC - SUNNYMEAD
FACILITY NUMBER: 331800090
VISIT DATE: 09/21/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809.

LPA reviewed random staff and resident files. Staff present have a criminal background clearance on file and are associated to the facility. The facility’s last fire drill was held on 8/21/2023 and disaster drills are conducted on a monthly basis. LPA observed fire alarms, smoke and carbon monoxide detectors and fire extinguishers throughout the facility.

Client #1 (C1) has updated physician's report and signed admission agreement on file. C1's Individual Program Plan (IPP) on file was approved on 10/31/2019 and Individual Service Plan (ISP) generated by the facility is dated 9/1/2022. Client #2's IPP on file was approved on 5/24/2021 and their ISP is dated 5/10/2022. Deficiency cited. Client #3, Client #4 and Client #5 have an updated IPP, physician's report, and signed admission agreement on file.

During today’s visit, LPA observed one (1) deficiency faulting the facility. An exit interview was conducted and this report was reviewed and provided to Day Program Manager Smith along with an LIC809-D and Appeal Rights.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/21/2023 02:36 PM - It Cannot Be Edited


Created By: Janette Romero On 09/21/2023 at 02:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: UNLIMITED QUEST INC - SUNNYMEAD
FACILITY NUMBER: 331800090

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.3(a)
Modifications to Needs and Services Plan
(a) The licensee shall ensure that each client's written Needs and Services Plan is updated as often as necessary, but at least annually, to ensure its accuracy, and to document significant occurrences that result in changes in the client's physical, mental, psychological, and/or social functioning.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above in due to not having updated Needs and Services Plan for Client #1 (C1) and Client #2 (C2), which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/29/2023
Plan of Correction
1
2
3
4
Licensee agreed to update Needs and Services Plan for C1 and C2 and ensure that Needs and Services Plans are updated as often as necessary, but at least annually. Proof of correction for C1 and C2 will be submitted to LPA by close of business on POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Esquivel
LICENSING EVALUATOR NAME:Janette Romero
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3