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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800141
Report Date: 07/18/2024
Date Signed: 07/18/2024 01:26:23 PM

Document Has Been Signed on 07/18/2024 01:26 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:FIRST STEP INDEPENDENT LIVING INCFACILITY NUMBER:
361800141
ADMINISTRATOR/
DIRECTOR:		SLAUGHTER, LANAIRFACILITY TYPE:
775
ADDRESS:3654 HIGHLAND AVE STE 17TELEPHONE:
(909) 483-2505
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 75CENSUS: 57DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Tyresha Beverly, Program SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Tyresha Beverly, Program Supervisor and was granted entry to the facility. At the time of the visit there was (21) staff, and fifty seven (57) clients present. The facility is an Adult Day Program (ADP) facility Licensed capacity is (75) current census (17). LPA was accompanied by Ms Lopez to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. Ms Beverly confirmed that the fire alarms and sprinklers are maintained and monitored annually by the Fire Department. Outside vendor maintain fire extinguishers. The carbon monoxide detector was tested and found to be in working order. 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. There was a designated storage space for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions. Water temperature measures 113.0 degrees F.

Food Service: At Day Program, clients are responsible to bring their own lunch. Facility has emergency snacks, and emergency water available for clients. Dishes, cups, and utensils were also stored properly.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: FIRST STEP INDEPENDENT LIVING INC
FACILITY NUMBER: 361800141
VISIT DATE: 07/18/2024
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Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Ms Beverly.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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