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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425826
Report Date: 11/29/2023
Date Signed: 11/29/2023 10:02:25 AM

Document Has Been Signed on 11/29/2023 10:02 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SUPPORTING UNLIMITED POSSIBILITIES, INC.FACILITY NUMBER:
336425826
ADMINISTRATOR:STANGEL, DEBORAHFACILITY TYPE:
775
ADDRESS:14137 BUSINESS CENTER DRIVETELEPHONE:
(951) 214-6833
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 75CENSUS: 22DATE:
11/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Program Manager, Mecca HudsonTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA was greeted and was granted entry and met with Program Manager, Mecca Hudson, who was informed of the purpose of the visit.

The facility is a one story building with (8) activity rooms and (5) bathrooms. The facility does not have a pool or fire arms. The facility is an adult day program for individuals ages 18 to 59. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following:

Infection Control: LPA observed the hand washing stations in the facility had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a plan on how to mitigate infectious diseases.

Physical Plant: Floors, windows, doors, fixtures and furniture were present and in good repair. The facility was observed to be free of hazards. The facility's outdoor area was observed to be free of hazards and contained outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 106.8F. Technical advisory note is issued as (2) restrooms tested were found to have a maximum temperature of 101.3F.

Food Service: The facility offers (1) snack during program. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed food supply was in sufficient numbers to accommodate residents.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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 3
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: SUPPORTING UNLIMITED POSSIBILITIES, INC.
FACILITY NUMBER: 336425826
VISIT DATE: 11/29/2023
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Record Review and Resident/Staff Files: LPA reviewed staff files and training that contained staff criminal clearance and updated training along with CPR/First Aid. Client files were reviewed and possessed all required paperwork.

Health Related Services/ Incidental Medical Services: Currently there are no clients enrolled that require medication administration during the program.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing last disaster drill conducted 11/28/23. LPA observed all facility exits were clear from obstructions.

No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Program Manager, Mecca Hudson.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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