<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880929
Report Date: 12/05/2024
Date Signed: 12/05/2024 02:58:12 PM

Document Has Been Signed on 12/05/2024 02:58 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:DAWSON HOMES INC. ON GLENWOOD AVENUEFACILITY NUMBER:
361880929
ADMINISTRATOR/
DIRECTOR:		HAWTHORNE, KENDRAFACILITY TYPE:
735
ADDRESS:2464 N. GLENWOOD AVE.TELEPHONE:
(909) 875-8327
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 4CENSUS: 3DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:34 AM
MET WITH:Latanya Williams-StaffTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with staff, Latanya Williams and Francisca Villalon and introduced self and stated purpose of the visit. LPA was informed that all 3 clients are on their way to program.

The facility has 4 bedrooms, 2 bathrooms, kitchen, dining area, living room, family room, office area, backyard, and attached garage. LPA completed a walk through of facility, review of records, P&I and medication audit.

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 71 degrees fahrenheit. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA observed that the client's bathroom inside their bedroom is being used as public or general passageway. Deficiency issued. LPA inspected client bathrooms; bathrooms were clean and appliances were found functional. LPA observed that the facility did not have a complete supply of hygiene products for the clients. Deficiency issued. Water temperatures tested at 113 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, charged fire extinguisher, first aid kit, emergency kits and emergency food and water. Posters such as; the personal rights, disaster plans, CCL complaint poster, and license were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked and inaccessible to clients. There was a designated storage space for client/staff files. Medications was observed locked and inaccessible to clients. There is no swimming pool, bodies of water, firearms or ammunition in the facility. LPA observed a broken kitchen cabinet, broken window screen from the kitchen and client bedroom in the front, missing client's bedroom window screen on the left side of the home, broken light switch inside the client's bedroom, and a chipped wall inside the main bathroom. Deficiency issued.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 12/05/2024 02:58 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 12/05/2024 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAWSON HOMES INC. ON GLENWOOD AVENUE
FACILITY NUMBER: 361880929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85095.5(c)(1)(D)
Infection Control Requirements
(c) An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 85022.  (1) The Infection Control Plan shall include all of the following:  (D) The licensee shall review the use of infection control procedures in the facility at least annually, if local government public health determines an epidemic outbreak has occurred, or if the review is requested by the local licensing agency. 

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above by not having an Infection Control Plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2024
Plan of Correction
1
2
3
4
Licensee stated that she will create an Infection Control Plan and send a copy to LPA via email by POC due date.
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by not having the facility safe and in good repair which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2024
Plan of Correction
1
2
3
4
Licensee stated that she will address and repair the broken kitchen cabinet, broken window screen from the kitchen and front client bedroom, missing client's bedroom window screen on the left side of the home, broken light switch inside the client's bedroom, and chipped wall inside the main bathroom. Licensee will send pictures of repairings and invoices to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 12/05/2024 02:58 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 12/05/2024 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAWSON HOMES INC. ON GLENWOOD AVENUE
FACILITY NUMBER: 361880929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85087(a)(4)
Building and Grounds
(4) No client bedroom shall be used as a public or general passageway to another room, bath or toilet.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above by invading the client's bedroom privacy by using it as a general passageway to the bathroom which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2024
Plan of Correction
1
2
3
4
Licensee stated that she will review the regulation with all staff and submit proof of attendance to LPA via email by POC due date.
Type B
Section Cited
CCR
85088(c)
Fixtures, Furniture, Equipment, and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review the licensee did not comply with the section cited above by not providing all types of hygiene products which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
1
2
3
4
Licensee stated that she will purchase the missing hygiene products and send pictures of products and receipts to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 12/05/2024 02:58 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 12/05/2024 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAWSON HOMES INC. ON GLENWOOD AVENUE
FACILITY NUMBER: 361880929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80026(h)
Safeguards for Cash Resources, Personal Property and Valuables
(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above by not maintaing accurate records of the clients P&I which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
1
2
3
4
Licensee stated that she will review, update, correct and balance the clients P&I records and send a picture of the corrected records to LPA via email by POC due date.
Type B
Section Cited
CCR
85064(b)
Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above by not having a current administrator's certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
1
2
3
4
Licensee stated that she will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 12/05/2024 02:58 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 12/05/2024 at 01:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAWSON HOMES INC. ON GLENWOOD AVENUE
FACILITY NUMBER: 361880929

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80065(f)(4)
Personnel Requirements
(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (4) Assistance with prescribed medications which are self-administered.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above by not assisting the clients with their prescribed medication by physician's orders which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/12/2024
Plan of Correction
1
2
3
4
Licensee stated that all staff will be retrained on medication and the MARS will be corrected as doctor's orders and will send proof of attendance sheet to LPA via email by POC due date.
Type B
Section Cited
CCR
80070(d)
Client Records
(d) All client records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above by not having the clients admission agreements available for inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/09/2024
Plan of Correction
1
2
3
4
Licensee stated that she will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
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: DAWSON HOMES INC. ON GLENWOOD AVENUE
FACILITY NUMBER: 361880929
VISIT DATE: 12/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Food Service: Non-perishable and perishable food supply is sufficient. Facility has a wide variety of food available. Dishes, cups, and utensils were also stored properly.

Yards/Outside: One shaded patio, side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: LPA reviewed administrator and staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the facility did not have a qualified administrator since their certificate expired since 10/1/23. Deficiency issued. LPA reviewed client files for admission agreements, updated physician reports, and needs and services plans. LPA was not given access to inspect all clients admission agreements since the present staff did not have access. Deficiency issued. P&I funds was audited and did not match with records. LPA observed discrepancies in the clients cash records like missing signatures from staff and clients, totals not up to date, and a difference in cash. Deficiency issued. LPA observed that the facility used the client's P&I cash to purchase a belt to use as a restraining device on the wheelchair for program. Technical assistance issued. Medication was audited and appeared to not be dispensed appropriately. LPA observed that staff is not assisting the client with their prescribed medication due to a MARS error for two medications. Deficiency issued. LPA reviewed facility's file for emergency drills, emergency disaster plan, liability insurance and surety bond. LPA observed that the facility did not have an Infection Control Plan. Deficiency issued. LPA observed that the Emergency Disaster Plan is not updated to the most current form. Technical violation issued.

Deficiencies and technical violations were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D and appeal rights were discussed and copies were provided to staff, Latanya Williams.

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

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
Page: 8 of 8