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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800469
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:12:55 PM

Document Has Been Signed on 10/03/2023 02:12 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:RAPHA HOUSEFACILITY NUMBER:
331800469
ADMINISTRATOR:KNIGHTEN, CASSANDRAFACILITY TYPE:
735
ADDRESS:13310 OCOTILLO ROADTELEPHONE:
(951) 378-3800
CITY:WHITEWATERSTATE: CAZIP CODE:
92282
CAPACITY: 4CENSUS: 4DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Tiffani Washington, Staff MemberTIME COMPLETED:
02:20 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Rapha House unannounced to conduct an Annual Inspection. LPA rang the doorbell and was greeted by Staff Member, Tiffani Washington, (S1). LPA introduced self and stated purpose of the visit. LPA granted entry to facility and provided space to work.

The facility has 4 resident bedrooms, 2 bathrooms, a kitchen, dining area, living room, attached garage, and backyard. The facility is a level 4I designated home vendorized by Inland Regional Center. LPA conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable 75 degrees in Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were operational. LPA tested the temperature from the kitchen faucet, which read between 108 to 111 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Last disaster drill conducted on 9/19/23, per staff. Posters such as; the personal rights and disaster plans were posted in a common areas. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure locations inaccessible to residents. Medications were also observed secure and inaccessible to residents. The facility had emergency and first aid kits readily available for residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.
Food Service: Non-perishable and perishable food supply is sufficient for number of clients residing in the facility. Facility has a variety of food and snacks available for residents. Dishes, cups, and utensils were also stored properly. Emergency food and water observed in the attached garage.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RAPHA HOUSE
FACILITY NUMBER: 331800469
VISIT DATE: 10/03/2023
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Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department.
Record Review: LPA reviewed 4 client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed 2 staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members.

Based on observations, no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Licensee; signature acknowledges understanding and receipt of report and attachments.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC809 (FAS) - (06/04)
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