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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800484
Report Date: 08/05/2024
Date Signed: 08/05/2024 02:26:28 PM

Document Has Been Signed on 08/05/2024 02:26 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:VIA GENOAFACILITY NUMBER:
331800484
ADMINISTRATOR/
DIRECTOR:		CORONA, PAULINA MFACILITY TYPE:
735
ADDRESS:47018 VIA GENOATELEPHONE:
(442) 324-0287
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 4CENSUS: 4DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:42 PM
MET WITH:Paulina Corona, administratorTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced annual required visit. LPA was granted entry and met with administrator Paulina Corona who was informed of the purpose of the visit. At the time of the visit there were 2 staffs and 1 client present.

The facility is a single story home with 4 bedrooms and 2 bathrooms with attached garage. There is no swimming pool in this property. There is no known firearms or other dangerous weapons stored at the facility. The clients served are adults between 18 and 59. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted staff interview. LPA observed the following:

The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed Five (5) staff files. All staffs have criminal clearance and updated training along with CPR/First Aid Certification. Four (4) client files were reviewed and possessed all required paperwork.



LPA observed the client bedrooms and staff office. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture in good repair were present. The outdoor area was observed to be free of hazards. LPA observed enough number of chairs in the backyard. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke and carbon monoxide detectors were operational, and the hot water temperature was 116 degrees F.

Continued on LIC809C...

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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 2
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: VIA GENOA
FACILITY NUMBER: 331800484
VISIT DATE: 08/05/2024
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LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

Adequate staffs are present for the supervision of clients during the visit. LPA also reviewed the staff schedule showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate.

All client medications were locked in a cabinet located in the kitchen. LPA reviewed medications for two(2) clients and found all medication listed on MARs and all required labeling was found to be in place. LPA observed first aid kit with all required items in kitchen area.



LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility performs quarterly fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies and PPE in the garage.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview was conducted where a copy of this report was provided to administrator, Paulina Corona.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC809 (FAS) - (06/04)
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