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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881153
Report Date: 06/10/2024
Date Signed: 06/10/2024 10:14:49 AM


Document Has Been Signed on 06/10/2024 10:14 AM - 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:WESTWARD RESIDENTIAL CAREFACILITY NUMBER:
331881153
ADMINISTRATOR:YBANEZ, ROSYFACILITY TYPE:
735
ADDRESS:156 FOX TROTTER PLACETELEPHONE:
(951) 665-3767
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY:4CENSUS: 3DATE:
06/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Rosy YbanezTIME COMPLETED:
10:15 AM
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On 6/10/2024, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to conduct an annual required inspection. LPA was greeted and granted entry by Caregiver, Adriana Mejia who was informed of the purpose of the visit. Administrator, Rosy Ybanez arrived during the visit. The facility has a fire clearance for three (3) ambulatory and one (1) non-ambulatory clients and serves adults ages 18 through 59.

During the visit, there was one (1) client and one (1) staff present and LPA was informed two (2) clients were out in the community. LPA toured the facility with Caregiver Mejia. During the tour, LPA observed the facility is made up of a one (1) story home with four (4) client bedrooms and two (2) bathrooms along with a kitchen, dining room, living room and attached garage. There are no bodies of water on the premises. Indoor and outdoor passageways are free of obstruction. LPA observed charged fire extinguishers mounted throughout the facility. Caregiver Mejia tested one (1) of the smoke alarm/carbon monoxide detectors and LPA observed it to be operational. LPA observed kitchen area to be clean. LPA observed the facility had a 2-day supply of perishable foods and 7-day of non-perishable food items. Food is stored in a safe and healthful manner. Medications were secured in a hallway closet. LPA reviewed physical medications for two (2) clients as well as Medication Administration Record and did not discover any discrepancies. Client files reviewed had updated Individual Program Plans and signed admission agreements. Client bedrooms were each furnished with a bed, chair, closet, clothing storage and lighting. Bathrooms have a working toilet, wash basin and non-skid mats in the shower. The hot water temperature in the bathrooms measured at 110- and 113-degrees Fahrenheit. The facility safeguards the clients' cash resources. Administrator Ybanez reviewed the Record Of Client's/Resident's Safeguarded Cash (LIC405) for two (2) clients along with their physical monies and LPA did not discover any discrepancies. Staff present have a criminal record clearance on file and are associated with the facility. Outdoor shaded seating area is available for the clients. 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 to Administrator, Ybanez.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janette RomeroTELEPHONE: (951) 529-2930
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024
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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