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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425787
Report Date: 02/21/2025
Date Signed: 02/21/2025 03:00:02 PM

Document Has Been Signed on 02/21/2025 03:00 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:BEHAVIORAL EDUCATION PROGRAMS-SKYLAND ADULT RESID.FACILITY NUMBER:
336425787
ADMINISTRATOR/
DIRECTOR:		JOSEPH SANTOSFACILITY TYPE:
735
ADDRESS:24518 SKYLAND DRIVETELEPHONE:
(951) 243-9472
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6CENSUS: 6DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Caregiver- Cindy BreheimTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 02/21/25, Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caregivers Cindy Breheim and Ma Luisa who were informed of the purpose of the visit. Caretakers informed LPA that four (4)clients were present at the facility and two (2) were attending day program. The facility has a fire clearance for six (6) non ambulatory clients and serves adults ages 18 through 59.

LPA toured the facility and reviewed client and staff records. During the tour, LPA observed the facility is made up of a one (1) story home with three (3) client bedrooms, one (1) staff bedroom, one(1) staff bathroom and one (1) client bathroom, a living room, dining room and laundry room and attached garage. All client bedrooms had the required furniture and lighting. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. LPA observed that laundry cabinet was filled with clean towels, blankets, and linen, available for the clients; LPA observed that the laundry room also had a locked closet that contained cleaning solutions and disinfectants. LPA toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA observed knives and sharp instruments secured in locked kitchen cabinet. Caretaker tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed three (3) charged fire extinguishers mounted throughout the facility. Medications are secured in a locked in a kitchen cabinet.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BEHAVIORAL EDUCATION PROGRAMS-SKYLAND ADULT RESID.
FACILITY NUMBER: 336425787
VISIT DATE: 02/21/2025
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LPA reviewed the Medication Administration Record along with the physical medications for three (3) clients and did not discover any discrepancies. LPA reviewed random client files and observed clients had updated Individual Program Plans and signed admission agreements. The facility conducts the emergency disaster drill each month. LPA reviewed the facility's Fire and Training Earthquake Log and last emergency drill was conducted on 01/23/25. LPA reviewed the Record of Client's/Resident's Safeguarded Cash Resources (LIC 405) and Caretaker reviewed the physical monies for one (1) client, and no discrepancies were discovered. Exit signs, emergency contact information, client's personal rights, and complaint information are visibly posted near the front entrance.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted, and a copy of this report was reviewed.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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