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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336402596
Report Date: 07/10/2024
Date Signed: 07/10/2024 05:15:43 PM

Document Has Been Signed on 07/10/2024 05:15 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:SLB INCORPORATED-BAMBIFACILITY NUMBER:
336402596
ADMINISTRATOR/
DIRECTOR:		FORTAJADA, JAMIELAHFACILITY TYPE:
735
ADDRESS:13331 BAMBI COURTTELEPHONE:
(951) 653-0604
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 6DATE:
07/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Jeffrey CastilloTIME VISIT/
INSPECTION COMPLETED:
05:16 PM
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Licensing Program Analyst (LPA) Valerie Flores and Stephanie Martinez conducted an unannounced annual required visit. LPA's Valerie Flores and Stephanie Martinez were granted entry and met with Administrator, Jeffrey Castillo, who was informed of the purpose of the visit. LPA's conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA's observed the following:

Physical Plant: LPA's observed the client and staff bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA's observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. No bodies of water were observed. Hallways and passageways were free of obstructions. Fire alarms and carbon monoxide detectors were in good working conditions. Resident medications was centrally stored and locked in a cabinet located in the kitchen.


Food Service: LPA's observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA's observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.
Record Review: Record review include but are not limited to first-aid training, emergency disaster training, CPR training and more. Staff had criminal record clearance on file along with fingerprint clearance. An Individual Program Plan (IPP) and Medical Assessment (Physician's Report) was on file for client in care.
Medication: Medication was reviewed for client in care. All medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to clients in care.

The home appears to be operating well within regulatory requirements. This report was reviewed with Administrator Castillo and a copy was provided. No deficiencies were cited at time of inspection.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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