<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911233
Report Date: 01/06/2025
Date Signed: 01/06/2025 12:36:11 PM

Document Has Been Signed on 01/06/2025 12:36 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LA POSADA IIFACILITY NUMBER:
360911233
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ORFA RUTHFACILITY TYPE:
740
ADDRESS:3875 NORTH BELLE STREETTELEPHONE:
(909) 881-1344
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 11TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Administrator, Ruth ChinovskyTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/06/2025 at 8:40AM, Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator, Ruth Chinovsky and introduced self and stated the purpose of the visit. LPA observed four (4) residents in care.

The facility has 6 bedrooms, 3 bathrooms, kitchen, dining area, living room, office, laundry, attached garage, swimming pool and backyard with 1 shed. LPA completed a walk through of facility, review of records and medication audit.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 120 degrees Fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguishers and first aid kit.

Posters such as; the personal rights, emergency disaster plan, CCLD complaint poster and ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to residents. There was a designated storage space for resident/staff files. Medications were observed to be locked and inaccessible to residents. There are no firearms or ammunition in the facility. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.
Karen ClemonsTELEPHONE: (951) 836-2748
Renese Howell-SmallTELEPHONE: (951) 248-2222
DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LA POSADA II
FACILITY NUMBER: 360911233
VISIT DATE: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Food Service: Non-perishable and perishable food supply is sufficient for residents in care. Dishes, cups, and utensils were also stored properly.

Yards/Outside: One shaded patio, side gate with self-latching handle on the left side of the house that leads into the backyard, one shed used for storage and one inaccessible swimming pool with locked self latching gate observed.



Record Review: LPA reviewed staff and administrator files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed resident files for admission agreements, updated physician reports, and needs and services plans.

No deficiencies were cited during this visit. A Technical Assistance was given to assist with the organization of distributing medication. An exit interview was conducted where this report LIC809, LIC809C and LIC9102 were discussed and copies were provided to Administrator, Ruth Chinovsky.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2748
LICENSING EVALUATOR NAME: Renese Howell-SmallTELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3