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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880835
Report Date: 11/24/2021
Date Signed: 11/24/2021 03:39:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VISTA BLUE MOUNTAINFACILITY NUMBER:
361880835
ADMINISTRATOR:KELLEY LARAFACILITY TYPE:
740
ADDRESS:22325 BARTON ROADTELEPHONE:
(909) 420-0153
CITY:GRAND TERRACESTATE: CAZIP CODE:
92313
CAPACITY:150CENSUS: 82DATE:
11/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Virgina "Ginnie" WessbergTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Anna Bueno and Bernadette Allen conducted an unannounced visit to the facility for a required annual inspection, with an emphasis on the infection control domain. LPA’s met with Administrator-Virgina Wessberg-aka Ginnie who confirmed there are no active and/or suspected Covid-19 cases in the facility. Hand sanitizer dispensers were observed throughout the facility.

LPA’s confirmed the facility has an adequate supply of cleaning and disinfectant provisions. The facility has a single-entry point to the main lobby and has a sign-in policy for universal entry screening. The facility also documents daily temperature and COVID-19 symptom checks for all visitors while residents are subject to routine symptom screening and regular observations for any change in condition. LPA observed all staff are properly fitted with face coverings. Continued weekly routine testing for staff is still observed.

LPA Anna Bueno, Bernadette Allen, and Virgina Wessberg toured the facility inside and out. Virgina confirmed that the fire clearance inspection was inspected monthly latest date is 11/2/2021. Sprinklers and fire extinguishers are maintained and monitored by an outside vendor.

SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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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