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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880496
Report Date: 11/08/2022
Date Signed: 02/03/2023 02:05:09 PM

Document Has Been Signed on 02/03/2023 02:05 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:BRACOST IIFACILITY NUMBER:
361880496
ADMINISTRATOR:ILEANA MARQUESFACILITY TYPE:
735
ADDRESS:2105 HARRIS STREETTELEPHONE:
(909) 376-3517
CITY:COLONSTATE: CAZIP CODE:
92324
CAPACITY: 6CENSUS: 5DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:San Juana Najera, Staff MemberTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA) Amber Coleman and Anna Bueno made an unannounced visit to the Bracost II facility. LPA's were greeted and invited inside facility by San Juana Najera, Caregiver. Caregiver requested to take LPA temp. and sign into log. LPA observed a COVID station equipped with hand sanitizer, proper PPE and disinfectant solutions. Administrator Ileana Marques was also present during visit. LPA's discussed the purpose of the visit and were provided a walk through the facility by Administrator. San Juana reported that all staff and residents were fully vaccinated and there were no recent positive COVID test results nor were there any individuals currently with COVID symptoms. All staff members were observed wearing proper PPE in facility. Facility was free of debris, clear hallways and in comfortable temperature.

During the inspection, LPA and Administrator discussed the facility's infection control measures and other health and safety concerns. LPA Coleman observed necessary signs posted throughout the facility for infection Control; which were in accordance with the Department's guidelines. LPA observed that the facility is equipped with sufficient PPE, hand hygiene supplies, and sufficient cleaning/disinfecting provisions. 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 facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation of residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. Fire and Carbon Monoxide alarms were tested and found to be operational. LPA's observed kitchen sharps, chemicals and medications in secure cabinets in kitchen. Bathrooms found to be fully stocked with soap, paper supplies and wastebaskets.

Inspection Tool was utilized, Mitigation plan was reviewed. Facility was further inspected, and no deficiencies were noted.
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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