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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403818
Report Date: 05/22/2023
Date Signed: 05/22/2023 10:57:44 AM

Document Has Been Signed on 05/22/2023 10:57 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SAGINARIO RESIDENTIAL CAREFACILITY NUMBER:
336403818
ADMINISTRATOR:SHEILA SAGINARIOFACILITY TYPE:
735
ADDRESS:381 WEST ONTARIO AVENUETELEPHONE:
(951) 736-3025
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 6CENSUS: 5DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Licensee Sheila SaginarioTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit for a required annual inspection. Facility is an Adult Residential Facility licensed for six (6) ambulatory clients. LPA was greeted and granted entry by the licensee Sheila Saginario.
LPA toured the facility inside and out. Outdoor and indoor passageways were kept free of obstruction. The facility has charged fire extinguishers, operating fire alarm systems, and carbon monoxide detectors. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. LPA toured the client bedrooms. The client bedrooms had the required furniture and functional lighting. The facility had a supply of additional linen and extra hygiene items for the clients. The facility had a complete first aid kit available and the last disaster drill was conducted on 4/13/2023. Cleaning supplies, medications, and sharps were kept locked and inaccessible to the clients. LPA toured the client bathrooms. The hot water temperature measured within required limits at 107 degrees Fahrenheit. The outside of the facility had a shaded area with seating for client comfort. The facility does not have bodies of water. Administrator stated she fired her landscaper and was in process of hiring new help to clean.
LPA reviewed staff and client files. Staff files had the required documentation including a health screening report and first aid/CPR certification. LPA discovered the Administrators HIV/TB training was taken over 2 years ago, and is no longer valid. Administrator stated she has taken a recent training in 2022, however can not locate it at this time. Technical assistance issued. Client files had the required documentation including an admission's agreement, updated physician's reports, and appraisal/needs & services plans. LPA observed one clients’ placement checklist/agreement was missing #11, 80068(a)(1) objection of admission. LPA issued a technical violation. LPA reviewed medications. Medications were dispensed appropriately according to the physician's orders. Licensee has secured each consumer’s personal property and cash resources. LPA did not observe the facilities policy on visitation posted in a common area. Technical violation issued. Sufficient staff are employed and present in the facility to meet the needs of the consumers in care.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAGINARIO RESIDENTIAL CARE
FACILITY NUMBER: 336403818
VISIT DATE: 05/22/2023
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No deficiencies were issued during this visit. Two(2) technical violations and one(1) technical assistance was issued. An exit interview was conducted where this report was discussed and provided to the licensee Sheila Saginario, at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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