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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412255
Report Date: 02/10/2025
Date Signed: 02/10/2025 03:08:55 PM

Document Has Been Signed on 02/10/2025 03:08 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LIFESTYLE HOME CARE IIFACILITY NUMBER:
336412255
ADMINISTRATOR/
DIRECTOR:		MARY MATEASFACILITY TYPE:
740
ADDRESS:5417 SKYLOFT DRIVETELEPHONE:
(951) 360-1622
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Administrator-Mary MarteasTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Beena Singh conducted an unannounced annual required visit. LPA was greeted and granted entry to the facility by staff member Michael Cuba.

Staff Steven called Administrator Mary Mateas and informed administrator on the phone regarding the visit and administrator arrived shortly after at the facility. LPA explained the purpose of today's visit.
Facility has census of five (5) residents present at the facility.

LPA accompanied with conducted a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility was not operating over capacity or beyond any conditions and limitations on the license. There are no pools and other bodies of water located on the premises. Facility is being maintained at a comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Hot water temperature was measured at 114 degrees Fahrenheit in all resident bathrooms. There are grab bars for each toilet, bathtub and shower used by residents. The facility smoke detectors and carbon monoxide devices were tested and found to be in working order.

Posters such as personal rights, Ombudsman Poster, labor laws, and the disaster plan were posted in a common area and CCL complaint poster posted at the facility. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked. LPA Singh observed complete first aid kit and first aid book at the facility.

Efren MalagonTELEPHONE: (951) 202-6356
Beena SinghTELEPHONE: (951) 248-2222
DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LIFESTYLE HOME CARE II
FACILITY NUMBER: 336412255
VISIT DATE: 02/10/2025
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Food Service: There is a minimum of one week supply of nonperishable foods and 2 days of perishable foods.

Care and Supervision: The facility has ensured sufficient and competent staff to provide the services needed to meet resident needs.

Record Review: LPA Singh requested and reviewed three (3) resident and three (3) staff files. LPA Singh reviewed staff files for current CPR/First aid certificates, TB results, and required training's.


Administration: LPA Singh did not observe any excluded individuals on the premises at time of visit. The Administrator Mary Marteas appears to be on the premises a sufficient number of hours to manage and oversee the business operation.

Medical Related Services: Prescriptions and non-prescription PRN medications contain a signed and dated written order from a physician. Medications are centrally locked in the staff office and inaccessible to residents in care. Medications are being administered as prescribed by physician's directions.

No deficiencies cited. An exit interview was conducted where this report was provided and discussed with Mary Marteas.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Beena SinghTELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC809 (FAS) - (06/04)
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