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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800007
Report Date: 01/17/2023
Date Signed: 01/17/2023 02:56:52 PM


Document Has Been Signed on 01/17/2023 02:56 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:RYAN'S HOME CAREFACILITY NUMBER:
361800007
ADMINISTRATOR:ROJAS, FRANKLINFACILITY TYPE:
740
ADDRESS:1682 COULSTON STREETTELEPHONE:
(909) 894-4168
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: 6DATE:
01/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Liza Rojas, Staff MemberTIME COMPLETED:
03:35 PM
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Ryan's Care Home Facility unannounced to conduct a Plan of Correction visit to confirm that deficiencies cited during the previous visit were addressed. LPA introduced self to staff member Liza Rojas and explained the purpose of the visit. Staff member greeted and invited LPA inside facility. LPA signed in and was provided space in the kitchen to work.
Per Plan of Correction, Licensee agreed to have a Fire Inspection done. As well as update and complete resident chart's with correct information. Staff member provided LPA with the resident's charts. LPA observed 6 resident charts. Of 6 resident charts, 6 resident charts were observed to be completed, contain updated and correct information.

The facility had a fire inspection completed on 1/9/2023 by the San Bernardino & Riverside County Fire Department. No abnormalities noted. Fire Extinguishers fully charged and also inspected 1/9/2023.

Facility will receive a Letter of Deficiency Citation Cleared for the deficiency cleared during inspection.

An exit interview was conducted where this report (LIC809) was discussed and provided to Staff Member Liza Rojas.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023
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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