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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880948
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:16:30 PM

Document Has Been Signed on 09/27/2022 01:16 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:VNL ARF II LLCFACILITY NUMBER:
361880948
ADMINISTRATOR:SHEILA ZINDAFACILITY TYPE:
735
ADDRESS:1205 W. BOHNERT AVETELEPHONE:
(909) 990-0299
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 3CENSUS: 3DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:33 PM
MET WITH:Destiny Vilanueva, DSPTIME COMPLETED:
01:18 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced required annual visit with an emphasis on infection control. LPA met with Direct Support Professional (DSP) Destiny Villanueva who confirmed there are three clients in care, all of whom were at day program during today's visit. DSP Villanueva 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 visitors are subject to symptom screening. Clients are continually observed for any change in condition. LPA observed all staff are properly fitted with face coverings.

LPA Bueno and DSP Villanueva 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 consumer files are secured in a locked cabinet while sharps are kept in a safe. 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 Ms. Villanueva at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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