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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881066
Report Date: 03/19/2025
Date Signed: 03/19/2025 03:53:06 PM

Document Has Been Signed on 03/19/2025 03:53 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:REM CALIFORNIA, LLC - SKYLANDFACILITY NUMBER:
331881066
ADMINISTRATOR/
DIRECTOR:		FLORENCE, TAMARAFACILITY TYPE:
735
ADDRESS:24795 SKYLAND DRTELEPHONE:
(951) 601-3444
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 4CENSUS: 4DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Program Director, Cynthia GloriaTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 03/19/25, Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Program Director Cynthia Gloria who was informed of the purpose of the visit. The facility has a fire clearance for four (4) of which two (2) may be non-ambulatory. Facility serves adults ages 18 through 59.

LPA toured the facility and reviewed records. During the tour, LPA observed the facility is made up of a one (1) story home with four (4) client bedrooms, two and a half (2.5) bathrooms, a living room, dining room, laundry room and a garage. All client bedrooms had the required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA observed knives and sharp instruments secured in locked kitchen cabinet. Cleaning solutions and disinfectants are secured in a locked laundry room cabinet. Program director tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed one (1) charged fire extinguisher mounted near the living room wall. Medications are secured in a locked closet cabinet stored near the entrance.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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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: REM CALIFORNIA, LLC - SKYLAND
FACILITY NUMBER: 331881066
VISIT DATE: 03/19/2025
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 LPA reviewed random client files and observed clients had updated Individual Program Plans and signed admission agreements. The facility conducts their Fire Disaster drills on a quarterly basis; last quarterly drill was dated on 01/24/25. LPA reviewed the Record of Client's/Resident's Safeguarded Cash Resources , and no discrepancies were discovered. Exit signs, emergency contact information, client's personal rights, and complaint information are visibly posted throughout the facility.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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