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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360902944
Report Date: 02/22/2022
Date Signed: 02/22/2022 11:34:57 AM


Document Has Been Signed on 02/22/2022 11:34 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:INLAND CHRISTIAN HOME, INCFACILITY NUMBER:
360902944
ADMINISTRATOR:MARY WOLFFFACILITY TYPE:
741
ADDRESS:1950 SOUTH MOUNTAIN AVENUETELEPHONE:
(909) 983-0084
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:297CENSUS: 171DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Mary Wolff TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Bernadette Allen and Rohit Lama conducted an unannounced visit to the facility for an annual inspection. LPA met with Administrator Mary Woff.

LPA observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, clients, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and clients.

LPA toured independent Living, Memory Care, and Assisted Living facility inside and out.

The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. The outdoor and indoor hallways were free of obstruction.

Cleaning supplies and medications were kept in a safe and locked place.

The facility had a complete first aid kit and emergency supplies for LPA observed a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. The facility menu was available for review.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: INLAND CHRISTIAN HOME, INC
FACILITY NUMBER: 360902944
VISIT DATE: 02/22/2022
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The client rooms had the required furniture and sufficient lighting. There were handrails in all bathrooms to accommodate the needs for bathing and showers have non-slip flooring. The facility had a supply of additional linen and extra hygiene items for the clients. LPA measured the hot water temperature in the client bathrooms. The hot water temperature measured at 105.4 degrees F.

LPA observed hand sanitizer throughout the facility and a 30- day supply of PPE. All clients have at least a 30 -day supply of medications. LPA observed that all emergency contact information for the clients have been updated.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: (951) 897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022
LIC809 (FAS) - (06/04)
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