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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425334
Report Date: 02/25/2022
Date Signed: 02/25/2022 10:22:14 AM

Document Has Been Signed on 02/25/2022 10:22 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:COMMUNITY CROSSINGS INC.FACILITY NUMBER:
336425334
ADMINISTRATOR:ANDRADE, AUDREYFACILITY TYPE:
775
ADDRESS:27363 JEFFERSON AVE STE. JTELEPHONE:
(909) 477-0179
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: 60CENSUS: 60DATE:
02/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Martha Marshall, CaregiverTIME COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the day program to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Martha Marshall. Program Manager Audrey Andrade was unavailable due to being at the Rancho Cucamonga site. LPA explained the purpose of the visit. At the time of visit there were 6 staff and 0 participants present. The day program currently has zero positive or suspected Covid-19 cases. The day program is currently closed and offering remote services with the anticipated opening date for in person services of March 7, 2022.

During today's visit, LPA toured the day program and made observations regarding the infection control measures that the day program has implemented. The day program has an adequate amount of hand hygiene supplies (soap, hand sanitizer). All staff present were also observed wearing appropriate face coverings (surgical masks). The staff clean and disinfect multiple times a day with EPA approved cleaners.

The day program's mitigation plan was approved on March 26, 2021. The day program has a plan in place to monitor participants regularly for any changes in condition, which includes daily temperature checks upon entry and screening questions on a tablet. Should a consumer begin to exhibit any symptoms related to COVID-19, day program staff will contact the client's responsible party. The consumer will wait in the designated isolation room located in the Nurse's room until they are able to be picked up from the day program.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was provided to Martha Marshall.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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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