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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424628
Report Date: 10/16/2024
Date Signed: 10/16/2024 02:18:23 PM

Document Has Been Signed on 10/16/2024 02:18 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:ULTIMATE SOLUTIONS CARE FACILITY #2FACILITY NUMBER:
336424628
ADMINISTRATOR/
DIRECTOR:		KENNETH LEONARDFACILITY TYPE:
735
ADDRESS:10348 WELLS AVENUETELEPHONE:
(951) 729-5628
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 4CENSUS: 4DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Gloria Lynn Williams TIME VISIT/
INSPECTION COMPLETED:
02:40 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
Licensing Program Analyst (LPAs) Beena Singh and Paola Guerrero arrived unannounced to conduct the required annual visit to the facility. LPA Beena Singh called the administrator after arriving at the facility gate to open the gate for LPAs, administrator open the gate for us and met with Administrator Gloria Lynn Williams introduced self and stated purpose of the visit.

The facility has 4 bedrooms, 2 bathrooms, kitchen, dining room, living room, attached garage. The facility is 4g and vendorized by Inland Regional Center (IRC). LPA Beena Singh completed a walk-through of the facility, review of records, and P&I audit.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 75 degrees Fahrenheit. LPA Beena Singh inspected client bedrooms; they are equipped with required furniture such as: mattresses, night-stands, dresser, closet, chairs and sufficient lighting. LPA Beena Singh inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperatures tested at 116 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarm, 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. Cleaning supplies, toxins, sharps, medications, and other dangerous items 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. Overall, the facility is clean, in good repair, and operates in safe conditions for clients in care.

*** Continuation in LIC809C ***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ULTIMATE SOLUTIONS CARE FACILITY #2
FACILITY NUMBER: 336424628
VISIT DATE: 10/16/2024
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: A backyard was observed and an attached garage. Outdoor pathways were observed with plywood for the ongoing fence repair on the right side of the facility.

Food Service: LPA Beena Singh observed two (2) days’ supply of perishable foods and seven (7) days’ 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.

Records Review: LPA Beena Singh reviewed client files for admission agreements, updated physician reports, and needs and services plans. LPA Beena Singh also reviewed staff and administrator's file for First Aid/CPR certification, criminal record clearance, training, and health screenings and Tuberculosis (TB) test. Furthermore, P& I was audited, and no deficiencies observed.

An exit interview was conducted where this report were provided to Administrator Gloria Williams.

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

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2