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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412373
Report Date: 07/25/2024
Date Signed: 07/25/2024 12:17:45 PM

Document Has Been Signed on 07/25/2024 12:17 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:JOHN, TRACI, & COFACILITY NUMBER:
336412373
ADMINISTRATOR/
DIRECTOR:		SCHWAB, TRACIFACILITY TYPE:
735
ADDRESS:3680 ANCHORAGE ST.TELEPHONE:
(951) 392-2213
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 5CENSUS: 4DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Cristhian Rodriguez, House ManagerTIME VISIT/
INSPECTION COMPLETED:
12:20 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. The LPA was greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with Facility Manager, Cristhian Rodriguez; he 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. No pool or body of water was observed on the property. According to Rodriguez, 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. Hot water was tested and observed to be within regulatory requirements. Toilets, hand washing and bathing facilities were kept safe 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.

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. Dinning supplies were observed to be sufficient for client's in care.

RECORD REVIEW: Staff files had required training; including, but not limited to, first aid training. Emergency and Disaster training and Drills are being completed by care staff. Restricted Health Care Plans were observed on file. Staff had the required criminal record clearances. Medical Assessments (Physician's Reports) were on file for clients in care.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JOHN, TRACI, & CO
FACILITY NUMBER: 336412373
VISIT DATE: 07/25/2024
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Administrator, Traci Schwab has an active Administrator's certificate, which expires on 05/08/2025. Earthquake and fire drills are being completed.

MEDICATION: Medications were inspected for each 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.

Advisory Notices: The Infection Control Plan was not reviewed within a 12 month period. LPA observed the master bathroom to smell of urine. The exit gate in the backyard was difficult to open due to the latch requiring the wooden door to be lifted slightly in order to be released. Trash bag on the side of the home not properly stored. Table under the backyard patio had black stains and dirt on the table top. C1's bedroom had unknown stains and splatter on the walls and a baseboard was lifting up. Cob webs were observed in the window seal of the master bathroom. The bottom of the freezer had food crumbs and other dirt. No current IPPs were observed on file for C1, C3, C4. According to the facility manager, the IPP meetings have been completed for the clients; however, the plans have not been received from the Inland Regional Center. Hot water was tested and measured at 96.4 degrees Fahrenheit; not meeting regulatory requirements. These violations do not pose an immediate health and safety concern.

This report was reviewed with Facility Manager Rodriguez 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: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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