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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336405670
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:29:58 PM

Document Has Been Signed on 10/29/2024 04:29 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-MESA TOPFACILITY NUMBER:
336405670
ADMINISTRATOR/
DIRECTOR:		ELLEN AMANTEFACILITY TYPE:
735
ADDRESS:28331 MESA TOP TRAILTELEPHONE:
(951) 485-6779
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 6CENSUS: 6DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:17 PM
MET WITH:Elen Amante, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, made an unannounced visit to the facility for the purpose of conducting a required annual inspection. On today’s visit the LPA met with Administrator, Ellen Amante; she was notified of the purpose for the visit.

PHYSICAL PLANT: The Licensee is operating the facility within the conditions and limitations specified on the license. Clients appear to be protected against immediate hazards. Outdoor and indoor passageways are kept free of obstruction. A pool was observed on the property; the pool was observed to be securely maintained. According to the Administrator, there are no weapons kept in the home. Disinfectants, cleaning solutions, and poisons were inaccessible to clients in care. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Toilets, hand washing and bathing facilities were kept safe, sanitary, and in operating condition. Additional equipment for physically handicapped clients is available. The smoke and carbon monoxide alarms were tested and found to be operable. The interior and exterior areas of the home were observed to be very clean and safe. FOOD SERVICE: There was a variety of food which appeared to be selected and stored in a safe and healthful manner. Food supply of nonperishable and perishable foods was sufficient. The kitchen was observed to be clean and well organized. RECORD REVIEW: Staff files had required training; including, but not limited to, first aid training and emergency and disaster training. Restricted Health Care plans were observed on file. Staff present had the required criminal record clearances. Individual Program Plans (IPPs)/Appraisal Needs and Service Plans and Medical Assessment (Physician's Report) were on file for clients in care. Administrator Amante has an active Administrator's certificate. Emergency drills are being conducted by the facility. MEDICATION: Client medications were observed to be labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to unauthorized persons. EXIT: The home appears to be operating well within regulatory requirements. This report was reviewed with Administrator Amante and a copy was provided. No deficiencies were cited at time of inspection.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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