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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880582
Report Date: 08/09/2024
Date Signed: 08/09/2024 02:34:48 PM

Document Has Been Signed on 08/09/2024 02:34 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:HONEY BEAR RESIDENTIALFACILITY NUMBER:
361880582
ADMINISTRATOR/
DIRECTOR:		MENDOZA, MANUELFACILITY TYPE:
735
ADDRESS:12302 HONEYBEAR LNTELEPHONE:
(818) 792-7055
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 4CENSUS: 3DATE:
08/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Leylani Mendoza- Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) Michelle Echeverria and Lavette Farlow arrived unannounced to conduct the required annual visit to the facility. LPAs met with Assistant Administrator, Leylani Mendoza and staff Efeme Egere and introduced themselves and stated purpose of the visit. LPAs were informed that there are currently 3 clients in care.

The facility has 4 client bedrooms, 2 bathrooms, staff bedroom with private bathroom, a kitchen, dining area, living room, family room, laundry room, attached garage, and backyard. The facility is vendorized by Inland Regional Center. LPAs completed a walk through of facility, review of records and an audit of P&I and medication.

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 of 74 degrees farenheit. LPAs inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPAs inspected client bathrooms; bathrooms were clean and appliances were found functional. Water temperature tested at 108.8 degrees farenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and two charged fire extinguishers. Posters such as; the personal rights, disaster plan and CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secured cabinets and closets inaccessible to clients. There was a designated storage space for clients/staff files. Medications and first aid kit were observed in secure cabinets. The facility had emergency kits. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Food Service: Non-perishable food supply is sufficient for number of clients in care. LPAs observed that the facility did not have two days of perishables available. Technical violation issued. Dishes, cups, and utensils were also stored properly.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HONEY BEAR RESIDENTIAL
FACILITY NUMBER: 361880582
VISIT DATE: 08/09/2024
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Yards/Outside: One shaded patio, a side gate with self-latching handle on the right side of the house that leads into the backyard. One transportation van available for clients services. All outdoor pathways were free of obstructions.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department.

Record Review: LPAs reviewed 2 clients files for admission agreements, updated physician reports, and needs and services plans. LPAs also reviewed administrator and staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. P & I funds were counted at random and matched with the ledger. Medications were audited at random and appeared to be dispensed appropriately by staff. LPAs observed that one of the client's medication was missing from the inventory and later found in the to be destroyed medication bag. Technical violation issued. The facility last conducted a disaster drill on June 17, 2024.

Two technical violations and no deficiencies were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C and LIC9102 were discussed and copies were provided to assistant administrator Leylani Mendoza.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC809 (FAS) - (06/04)
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