<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424413
Report Date: 02/18/2025
Date Signed: 02/18/2025 12:27:27 PM

Document Has Been Signed on 02/18/2025 12:27 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:HAPPY FACES ADULT HOMEFACILITY NUMBER:
336424413
ADMINISTRATOR/
DIRECTOR:		SILVA, RINAFACILITY TYPE:
735
ADDRESS:10441 CAMPBELL AVENUETELEPHONE:
(951) 358-0263
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 6CENSUS: 4DATE:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:12 AM
MET WITH:Staff-Reyna ArvizuTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/18/2025 at 11:00 AM, Licensing Program Analyst (LPA) Beena Singh arrived unannounced to conduct the required comprehensive annual inspection to the facility. LPA Singh met with a staff, introduced self and stated the purpose of the visit. Licensee Rina Silva was contacted, informed of the visit and Licensee Rina Silva asked one of the staff member Reyna Arvizu to assist LPA Singh with the annual required visit today. Staff Care giver Francisca/ Reyna Arvizu arrived at the facility during the visit. LPA Singh stated the purpose of the visit to Staff- Francisca/Reyna Arvizu.

The facility has four (4) bedrooms, three (3) bathrooms, kitchen, dining room, and living room. The facility is vendorized by Inland Regional Center (IRC). LPA Singh completed a walk through of the facility, review of records, medication audit and P&I audit.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD), LPA Singh observed no client at the facility. Licensee Silva reported on the phone that all clients were out in the community. There are no obstructions to indoor and outdoor passageway of the facility. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit. LPA Singh inspected client bedrooms; they are equipped with required furniture such as: mattresses, storage space, chairs, and sufficient lighting. LPA Singh inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperatures tested at 114 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide detectors, charged fire extinguisher, and first aid kit with first aid book. Posters such as; the personal rights, CCL complaint poster, emergency disaster plan were posted in a common area. Sharps and medications were kept in secure cabinets inaccessible to clients. The facility had emergency kits, emergency food and water. There are no firearms and ammunition in the facility.

*** Continuation in LIC809C ***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HAPPY FACES ADULT HOME
FACILITY NUMBER: 336424413
VISIT DATE: 02/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Yards/Outside: One shaded patio, one (1) side gate with self-latching handle on the right side of the house that leads into the backyard. The outdoor pathway on the side of the facility was free of obstruction.

Food Service: LPA Singh observed two (2) day(s) supply of perishable food and seven (7) day(s) supply of non-perishables food and snacks. Dishes, cups, and utensils were stored properly.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.



Record Review: LPA Singh reviewed client files for Admission Agreements, Needs and Services Plans, Functional Capabilities, and Physician Report (LIC602). LPA also reviewed staff and administrator's file for First Aid/CPR certification, criminal record clearance, training, and health screenings with Tuberculosis (TB) Test result. Per LPA Singh records review, no issue observed. LPA Singh reviewed Clients 1 and 2s P&I records and LPA Singh observed no issue. LPA Singh reviewed C3 and C4 medications, LPA Singh observed no issue.

An exit interview was conducted where this report LIC809, LIC809C, were discussed and copies were provided to Licensee Rina/Walter Silva via email.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2