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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910501
Report Date: 01/04/2024
Date Signed: 01/04/2024 02:43:55 PM

Document Has Been Signed on 01/04/2024 02:43 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTAFACILITY NUMBER:
360910501
ADMINISTRATOR:HERNANDEZ, ANNABELLFACILITY TYPE:
775
ADDRESS:9160 MONTE VISTA AVE.TELEPHONE:
(909) 621-3884
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 66CENSUS: DATE:
01/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Annabell Hernandez, Program DirectorTIME COMPLETED:
02:46 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the OPARC-Monte Vista, Adult Day Program unannounced to conduct the Annual Inspection. LPA was greeted by Administrative Staff who informed Administrator, Annabell Hernandez of LPA's arrival. LPA introduced self and stated purpose of the visit. LPA was granted entry and provided space to work. LPA was informed the census of the day was 45

LPA was accompanied by Facility Administrator Annabell Hernandez to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is a store front building containing a total of 7 activity rooms, staff offices, bathrooms and outdoor activity space. Pathways throughout the facility were clear of obstructions and clutter. The facility was maintained at a comfortable temperature. Administrator reports that the facility does not serve meals to its consumers. A small food supply is maintained for consumers who may forget their lunch, drop or spill it or may not have enough food. LPA observed a kitchen inside the facility. Water temperature tested and recorded between 100 and 105 degrees fahrenheit. Administrator displayed a secure cabinet for the facility's chemicals, cleaning supplies and sharp objects. LPA also observed operable appliances such as a microwave, stove and washer/dryer. LPA adequate amounts of disposable dishware cups, and utensils for the consumer census. LPA observed fire extinguishers, (4) in each activity room. Each one was fully charged and last inspected May 2023.The facility is equipped with operating smoke detectors and carbon monoxide alarms. Program Manager reported that fire/disaster drills are conducted on a monthly basis. Last drill took place on 12/19/23. Sufficient lighting sufficient seating was observed throughout the facility. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. The designated storage space for consumer files and medications are the secure staff offices. Additionally, LPA

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTA
FACILITY NUMBER: 360910501
VISIT DATE: 01/04/2024
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observed six stations for infection control throughout the facility. As well as the facility's supply of personal protective equipment. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Based on observations and record reviews, no deficiencies are being cites. An exit interview was conducted were this report was reviewed, discussed then provided to Annabell Hernandez.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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