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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425826
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:57:52 AM

Document Has Been Signed on 11/07/2024 11:57 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/
DIRECTOR:		STANGEL, DEBORAHFACILITY TYPE:
775
ADDRESS:14137 BUSINESS CENTER DRIVETELEPHONE:
(951) 214-6833
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 75CENSUS: 42DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Licensee and Administrator, Deborah StrangelTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted a required annual visit. LPA met with Licensee and Administrator, Deborah Stangel, and Case Manager Mecca Hudson, who were informed of the purpose of the visit. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews.

The facility is a one story building with (9) 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.

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 clean and in good repair. The facility's outdoor area was observed to be free of hazards and contained outdoor furniture and shaded area for clients. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The hot water temperature read at 105F.

Food Service: The facility offers a 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 and appropriately stored.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SUPPORTING UNLIMITED POSSIBILITIES, INC.
FACILITY NUMBER: 336425826
VISIT DATE: 11/07/2024
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Record Review and Resident/Staff Files: LPA reviewed five staff files and training which contained staff criminal clearance and updated training along with CPR/First Aid. Five 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 10/30/2024. LPA observed all facility exits were clear from obstructions. The smoke and carbon monoxide, and fire extinguishers were operational as evidenced by fire inspection conducted on the alarm system.

No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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