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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800158
Report Date: 10/23/2023
Date Signed: 10/23/2023 12:05:55 PM

Document Has Been Signed on 10/23/2023 12:05 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:IN-ROADS DAY PROGRAM 4FACILITY NUMBER:
331800158
ADMINISTRATOR:ALICIA HAYNESFACILITY TYPE:
775
ADDRESS:4120-4130-4140-4150 E. FLORIDATELEPHONE:
(909) 864-1551
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 60CENSUS: 24DATE:
10/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Angelica Garcia, Executive DirectorTIME COMPLETED:
12:10 PM
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On 10/23/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct a case management visit regarding a report of possible HIPPA violation. LPA met with Executive Director, Angelica Garcia who was informed of the purpose of the visit.

It was alleged a staff member disclosed a client’s information on social media. LPA interviewed staff who acknowledged mentioned a client first name but denied disclosing any information. A screenshot of the comment was provided to LPA. The screenshot shows only client’s first name was mentioned. No personal or health information was disclosed.

Based on the information obtained during today's visit, no deficiencies were cited.



An exit interview was conducted, and a copy of this report was provided to Angelica Garcia.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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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