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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880786
Report Date: 06/23/2023
Date Signed: 06/23/2023 01:23:18 PM


Document Has Been Signed on 06/23/2023 01:23 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:SUMMERFIELD OF REDLANDSFACILITY NUMBER:
361880786
ADMINISTRATOR:HEDI CHARETTEFACILITY TYPE:
740
ADDRESS:1319 BROOKSIDE AVENUETELEPHONE:
(909) 793-9500
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:75CENSUS: 46DATE:
06/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Heidi Charette, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced required annual visit to the facility. LPA met with Administrator, Heidi Charette and discussed the purpose of the visit.

The facility is a Residential Facility for the Elderly (RCFE). Facility license capacity is (75) with a hospice waiver for (12) and a current census of (46). LPA conducted an overall inspection of the facility, which included but not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient activity space for residents in care. Planned activities were posted in a common area. The facility is maintained at a comfortable temperature of 75 degrees F. Facility has no outdoor bodies of water and no firearms. Outdoor facility space is gated for the protection of clients in care.
LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food the number of clients in care. Food is stored in a safe and healthful manner. Sharps are kept locked and inaccessible to clients in care. Refrigerators are working properly and tested at a temperature of 39 degrees F. Kitchen and dining areas are clean and sanitary.
LPA inspected (4) clients bedrooms. Bedrooms are equipped with mattresses, nightstands, chairs, storage space, sufficient lighting and linen. Faucets hot water tested between 105 and 115 degrees F.
LPA inspected (4) facility showering rooms. All equipment working properly and hot water tested between 106 and 107 degrees F.
Facility carbon monoxide and smoke alarms were working properly. Fire extinguishers were fully charged and serviced in May 2023. Facility telephone service is working properly.
Emergency disaster plan, theft and loss programs, personal rights, Ombudsman contact and Licensing Complaint posters were posted in a common area. Fire and evacuation drill was conducted on 4/23/2023.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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: SUMMERFIELD OF REDLANDS
FACILITY NUMBER: 361880786
VISIT DATE: 06/23/2023
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Client medications are kept in safe and locked cabinets inaccessible to clients in care. LPA reviewed (4) client medications and centrally stored medication logs. All medication were administered as prescribed and labeled as required by State and Federal laws.

LPA reviewed (4) staff files which had criminal record clearance, training, CPR/First Aide training and health screenings. LPA reviewed (4) client records which had admissions agreements, physician's reports, pre-admissions appraisals, personal rights statements.

Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. No deficiencies were cited during today's visit.

An exit interview was conducted, where this report was discussed and a copy of report with appeal rights was provided to the Administrator at the conclusion of the visit

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
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