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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425235
Report Date: 09/10/2024
Date Signed: 09/10/2024 11:59:29 AM

Document Has Been Signed on 09/10/2024 11:59 AM - 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:ARGUELLES HOMEFACILITY NUMBER:
336425235
ADMINISTRATOR/
DIRECTOR:		ARGUELLES, MARIAFACILITY TYPE:
735
ADDRESS:25308 CORAL CANYON RD.TELEPHONE:
(951) 603-3436
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 6CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Maria Arguelles,AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 09/10/2024 at 9:25AM, Licensing Program Analysts (LPA's) Renese Howell-Small and Magda Malcore conducted an unannounced visit to the facility to conduct the required comprehensive annual inspection to the facility. LPA's Small and Malcore were greeted by Carlos Arguelles, Maria Arguelles and Thiana Arguelles and gained access into the home. Licensee/Administrator Maria Arguelles was informed of the purpose of the visit.

The facility has five (5) bedrooms, four (4) bathrooms, kitchen, dining room, living room, attached 3-car garage, and backyard. The facility is vendorized by Inland Regional Center (IRC). LPA's Small and Malcore completed a walk through of the facility, review of records, and medications audit.



Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD), LPA's Small and Malcore observed zero clients during the visit, all attended day program. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPA's Small and Malcore inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, chairs, and sufficient lighting. LPA's Small and Malcore inspected client bathrooms; bathrooms were clean, and appliances were found functional. Water temperatures tested at 107 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide detectors, charged fire extinguishers, and first aid kit with first aid book.

Posters such as; the personal rights, CCLD complaint poster, labor laws, and emergency disaster plan were posted in a common area. Client medications were kept in secure cabinets inaccessible to clients. LPA's Small and Malcore observed night lights in the hallway leading to clients' shared bathrooms. The facility had emergency kits, emergency food and water. There are no firearms and ammunition in the facility.
*** Continuation in LIC809C ***
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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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: ARGUELLES HOME
FACILITY NUMBER: 336425235
VISIT DATE: 09/10/2024
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Yards/Outside: One shaded patio and one side gate with self-latching handle on the left side of the house that leads into the backyard, attached three (3) car garage observed. All outdoor pathways were free of obstructions.

Food Service: LPA's Small and Malcore 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's Small and Malcore reviewed four (4) client files for admission agreements, medical assessments/physician reports, Individual Program Plan (IPP) and Personal and Incidentals (P&I). LPA's Small and Malcore observed all of client files that were reviewed to be complete. LPA's Small and Malcore also reviewed staff and administrator's file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA's Small and Malcore observed all of staff files were complete. LPA's Small and Malcore audited three (3) client's Personal and Incidental (P&I) and no issues were observed.

There were no deficiencies cited during this visit. An exit interview was conducted where this report LIC809, LIC809C and (Appeal Rights) were discussed, and copies were provided to Licensee/Administrator Maria Arguelles.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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