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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426847
Report Date: 09/27/2022
Date Signed: 09/27/2022 09:10:51 AM

Document Has Been Signed on 09/27/2022 09:10 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:FAIRMOUNT RESOURCE CENTER-UP IN MOTIONFACILITY NUMBER:
336426847
ADMINISTRATOR:OSCAR CABRALESFACILITY TYPE:
775
ADDRESS:2190 MARKET STREET, SUITE DTELEPHONE:
(951) 367-0856
CITY:RIVERSIDESTATE: CAZIP CODE:
92501
CAPACITY: 60CENSUS: 39DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Oscar Cabrales - AdministratorTIME COMPLETED:
09:15 AM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Administrator Oscar Cabrales and advised him of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Oscar Cabrales, and reviewed the facility's Mitigation Plan. Clients have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels, and hand washing guides are posted. Upon entering the facility, LPA Colvin observed postings for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply. LPA Colvin observed a dedicated isolation room with PPE located outside along with a list of approved staff members to care for person(s) in isolation (staff are fit tested for N-95 masks). LPA Colvin went over the various recommended training for facility staff with Administrator Oscar Cabrales in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE.

LPA Colvin confirmed with Administrator Oscar Cabrales that clients, staff, and visitors are screened for COVID-19 symptoms prior to entering the facility, which LPA Colvin confirmed through being screened upon entry as well. LPA Colvin additionally observed a sign-in log for visitors, where their temperature is recorded as well as answers to screening questions. All facility staff have been vaccinated and new staff will present a negative COVID-19 test prior to start of employment. Consumers returning to facility for first time since closure will also present a negative COVID-19 test prior to returning to programming.

An exit interview was conducted with Administrator Oscar Cabrales and a copy of this report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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