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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880851
Report Date: 02/02/2024
Date Signed: 02/02/2024 03:38:41 PM


Document Has Been Signed on 02/02/2024 03:38 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:SUNNY TRAIL HOMEFACILITY NUMBER:
361880851
ADMINISTRATOR:LLADONES, RAPHAELFACILITY TYPE:
735
ADDRESS:1829 WEST ASH STTELEPHONE:
(909) 344-0034
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:4CENSUS: 3DATE:
02/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Raphael LladonesTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Anna Bueno arrived at the facility at 1:27 PM to conduct an unannounced required annual inspection. Direct support provider (DSP) Preston Fraley arrived at 1:52 PM and LPA identified herself to DSP who was informed of the purpose of today's visit. Licensee Raphael Lladones arrived at 1:56 PM. LPA introduced herself to Licensee and informed them of the purpose of the visit.

The facility is currently licensed as an Adult Residential Facility, vendored by the Inland Regional Center. The facility has capacity of four ambulatory clients. One staff and two clients arrived at the facility during the visit.

LPA Bueno and Licensee Lladones toured the interior and exterior of the facility. The facility has no bodies of water. There is a shaded area and recreational equipment in the backyard for client use. LPA and Licensee observed that side gate was unlocked and free of obstruction. The facility had a working telephone for use. The facility fire extinguisher was last inspected on 03/16/23 and LPA observed the fire extinguisher to be charged. Licensee tested the hallway smoke alarm and found the unit to be in working order. LPA and Licensee observed other smoke alarms in the facility were interconnected and began chiming. A locked centralized cabinet is used for medications while client and staff files and facility records are kept secured in a locked closet. Sharps, toxins, and cleaning agents are kept secured and locked in closets and cabinets..

The following were observed of the physical plant:
Client Bedrooms and Bathroom: LPA and Licensee observed all bedrooms to have the required bedding and furniture, such as, clean mattresses/linen, sufficient storage space, chairs, and lighting. The facility had a supply of additional linens and towels. LPA and Licensee observed bathrooms were kept in sanitary conditions and provisions for hygiene items are available.
Kitchen and Dining Areas: LPA and Licensee inspected the kitchen and found dishes, glasses, and utensils were in good condition and stored in a safe manner. LPA and Licensee inspected food provisions and found a 2-day supply of perishable food and 7-day supply of non-perishable food items. LPA and Licensee reviewed the facility menu posted on the refrigerator.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: SUNNY TRAIL HOME
FACILITY NUMBER: 361880851
VISIT DATE: 02/02/2024
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Common (living/activity/sitting) areas: LPA Bueno and Licensee Lladones observed adequate seating in the common areas. LPA observed activities in the office. Facility staff updated the calendar of activities.

The following records were inspected:
Client Records: LPA Bueno inspected client files and found all to have the required documentation, including but not limited to, placement and admissions agreement, current Individual Program Plan (IPP), and physician's report and proof of recent medical appointments.
Staff Records: LPA reviewed staff files. Administrator certificate is current. LPA reviewed training and disaster drill logs. LPA observed appropriate documents such as health screening/TB records and current CPR certificates. Emergency LIC610D is posted on the living room board for review.
Centralized Medication: LPA reviewed client medications. LPA and Licensee observed all scheduled medications were administered as prescribed.

Licensee shall send an electronic copy of their emergency disaster plan to LPA. No deficiency cited during today's visit. An exit interview was conducted where this report was provided to Licensee Lladones at the conclusion of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC809 (FAS) - (06/04)
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