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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800155
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:59:30 PM

Document Has Been Signed on 09/24/2024 12:59 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BRIGHT HORIZON OF EASTVALEFACILITY NUMBER:
331800155
ADMINISTRATOR/
DIRECTOR:		MANIQUIS, ROXANNEFACILITY TYPE:
735
ADDRESS:7067 STOCKTON DRIVETELEPHONE:
(951) 839-8714
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 4CENSUS: 1DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Lead Staff, Aichoro FuntilaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 09/24/2024 at 9:55 AM, Licensing Program Analysts (LPAs) Renese Howell-Small and Michelle Echeverria conducted an unannounced visit to the facility to conduct the required comprehensive annual inspection. LPA’s Small and Echeverria were greeted by a staff and gained access to the facility. Licensee/Administrator Roxanne Maniquis was contacted and informed of the visit. LPA’s Small and Echeverria explained the purpose of the visit to Administrator, Rochella Maniquis and Lead Staff, Aichiro Funtila.

The facility has four (4) bedrooms, two (2) bathrooms, kitchen, dining room, living room, attached two(2) car garage, and backyard. The facility is vendorized by Inland Regional Center (IRC). LPA’s Small and Echeverria completed a walk through of the facility, review of records, P&I funds and medications audit.



Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD), LPAs Small and Echeverria observed one (1) client during the visit. Two (2)) clients were out in the community. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA’s Small and Echeverria inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, chairs, and sufficient lighting. LPA’s Small and Echeverria inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperatures tested at 105.4 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide detectors, charged fire extinguisher, and first aid kit with first aid book.

Posters such as; the personal rights, CCLD complaint poster, labor laws, and emergency disaster plan were posted in a common area. Client medications were kept in secure cabinets inaccessible to clients. LPA’s Small and Echeverria observed night lights in the hallway leading to clients' shared bathroom. The facility had emergency kits and emergency food and water. There are no firearms and ammunition in the facility.
*** Continuation in LIC809C ***
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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Document Has Been Signed on 09/24/2024 12:59 PM - It Cannot Be Edited


Created By: Renese Howell-Small On 09/24/2024 at 12:07 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: BRIGHT HORIZON OF EASTVALE
FACILITY NUMBER: 331800155

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above by not obtaining a fire clearance in which the master bedroom was altered; making one bedroom into two, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/01/2024
Plan of Correction
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Licensee/Administrator will submit a statement of understanding on the regulation cited, copy of the STD850 to LPA Renese Howell-Small and submit to the regional office a completed STD850 Fire Clearance Request Form.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Clemons
LICENSING EVALUATOR NAME:Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024


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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BRIGHT HORIZON OF EASTVALE
FACILITY NUMBER: 331800155
VISIT DATE: 09/24/2024
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Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the left side of the house that leads into the backyard, attached two (2) car garage observed. All outdoor pathways were free of obstructions.

Food Service: LPA’s Small and Echeverria observed two (2) day(s) supply of perishable food and seven (7) day(s) supply of non-perishables food and snacks. Dishes, cups, and utensils were stored properly.


Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: LPA’s Small and Echeverria reviewed three (3) client files for admission agreements, medical assessments/physician reports, Individual Program Plan (IPP). LPA’s Small and Echeverria observed files reviewed were complete. LPA’s Small and Echeverria also reviewed staff and administrator's file for First Aid/CPR, trainings, criminal records clearance and health screenings. Small and Echeverria observed three (3) staff files to be complete .

LPAs Small and Echeverria audited three (3) clients’ medications and no issues were observed. LPA’s Small and Echeverria audited three (3) client's Personal and Incidental (P&I) and no issues observed.

A Civial Penalty was assessed.

An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC421IM and (Appeal Rights) were discussed, and copies were provided to Administrator, Rochella Maniquis..

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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