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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880495
Report Date: 11/08/2022
Date Signed: 11/08/2022 10:22:56 AM

Document Has Been Signed on 11/08/2022 10:22 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:BRACOST IFACILITY NUMBER:
361880495
ADMINISTRATOR:EDIMAR MARQUESFACILITY TYPE:
735
ADDRESS:1096 CANTARA STREETTELEPHONE:
(909) 376-3517
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 6CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Ileana Marques, AdministratorTIME COMPLETED:
10:25 AM
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Licensing Program Analysts (LPAs) Amber Coleman and Anna Bueno made an unannounced visit to the facility to conduct an annual inspection with an focus on infection control. LPAs met with Ileana Marques, Licensee who greeted and invited LPA's inside. Licensee reported that at this time there are no clients in the home. Licensee is in the process of updating the home with paint, new flooring, furniture and appliances. The home has been vendorized by the Inland Regional Center. There are no cases of COVID-19 within the facility.

During today's visit, LPAs toured the facility and made observations pertaining to the facility's infection control measures. Although LPAs did not observed licensing issued signage throughout the facility, there are no clients in care and Licensee Marques will have proper COVID-19 signage posted prior to the first client admission. LPAs observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and clients for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the resident's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Fire and carbon monoxide alarms were tested and operational. LPA's observed cabinets throughout the facility for securing medications, chemicals and sharp items.

Based on the observations made during today’s visit, there were no deficiencies cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided to Ileana Marques, Administrator
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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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