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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800238
Report Date: 01/18/2024
Date Signed: 01/18/2024 10:47:42 AM

Document Has Been Signed on 01/18/2024 10:47 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LENBERG RESIDENTIAL HOMEFACILITY NUMBER:
361800238
ADMINISTRATOR:VERNON COLEMANFACILITY TYPE:
735
ADDRESS:704 SOUTH ARROWHEADTELEPHONE:
(909) 265-1615
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 3CENSUS: 0DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Eric Evans, Direct Support ProviderTIME COMPLETED:
10:45 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Lenberg Residential Home, Adult Residential Facility to conduct the Annual Inspection. LPA knocked on the door and was greeted by Staff Member Eric Evan. LPA introduced self and stated purpose of the visit. LPA was granted entry and provided space to work. Mr. Evans accompanied LPA on a walk through of the facility and provided records for review. Mr. Evans contacted Administrator, Vernon Coleman to notify of LPA's visit. Administrator arrived later during the visit.

The facility is a residential home comprised of 3 resident bedrooms, 2 bathrooms, kitchen, dining room, living room, attached garage, and backyard. The facility maintains a partnership with the Inland Regional Center at Level 4I. LPA conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating at the capacity approved by Community Care Licensing (CCL). Pathways were observed to be free of obstruction. The facility observed in comfortable temperature. LPA inspected resident bedrooms and found that each room was equipped with required furniture such as: bed with adequate linens, night stands, adequate storage space and sufficient lighting. LPA inspected bathrooms. LPA observed that each bathroom included adequate hand hygiene, paper supplies and functional appliances. Fire/Smoke/Carbon Monoxide alarms were tested during the visit and found operational. Administrator reported fire and earthquake drills are conducted on a monthly basis. LPA observed posters such as: resident personal rights, licensing complaint, emergency contact information, staff schedule, food menu and disaster plans were posted in a prominent place. Cleaning supplies, toxins, sharps, and other dangerous items were observed in secure and inaccessible to residents in care. The facility maintains a staff area/office where facility, staff, resident files and medications are maintained securely.
Emergency food supply and first aid kits were observed and readily available for residents in care.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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 4
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: LENBERG RESIDENTIAL HOME
FACILITY NUMBER: 361800238
VISIT DATE: 01/18/2024
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Kitchen: LPA observed the kitchen. Non-perishable and perishable food supply is sufficient for number of residents in care. The facility offers a variety of food items such as bread, milk, eggs, fruits and vegetables. LPA observed dishware, cups, and utensils were observed in proper storage and in adequate amounts. Emergency food and water supply were also observed in the garage. LPA observed a fully charged fire extinguisher.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. LPA observed that all staff members currently employed, have criminal record clearance through the department.

Record Reviews: LPA reviewed 2 resident files for admission agreements, physician reports, and needs and services plans. LPA also reviewed 1 staff file for First Aid/CPR certification, criminal record clearance, training, and health screenings.


Based on observations, interviews and record reviews no deficiencies will be cited per Title 22, California Code of Regulations. An exit interview was conducted where this report was reviewed, discussed, then provided to Administrator, Vernon Coleman.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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