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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880929
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:09:59 AM

Document Has Been Signed on 09/22/2022 10:09 AM - 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:DAWSON HOMES INC. ON GLENWOOD AVENUEFACILITY NUMBER:
361880929
ADMINISTRATOR:HAWTHORNE, KENDRAFACILITY TYPE:
735
ADDRESS:2464 N. GLENWOOD AVE.TELEPHONE:
(909) 875-8327
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 4CENSUS: 4DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Kendra HawthorneTIME COMPLETED:
10:11 AM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced annual required visit, with an emphasis on infection control. LPA met with Administrator Kendra Hawthorne who confirmed there are four clients in care. Administrator Hawthorne verified that there are no active Covid cases in the home.

This facility submitted a mitigation plan to Community Care Licensing (CCL) to mitigate the spread of COVID-19 in the facility. Single entry point at the front door has a sign-in policy for universal entry screening. The facility continues to document daily temperature and COVID-19 symptom checks for clients and staff, and visits are subject to routine symptom screening and regular observations for any change in condition. LPA observed all staff are properly fitted with face coverings.

LPA Bueno and Administrator Hawthorne toured the facility inside and LPA toured the outside. The facility has no bodies of water. The facility has operating smoke alarms and carbon monoxide detector. Medication and sharps are kept in a safe and locked cabinet. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The client bedrooms had the required furniture and sufficient lighting.

LPA Bueno observed no health and safety concerns at the time of visit. The facility appears to be meeting operational compliance. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Hawthorne at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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