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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880948
Report Date: 11/11/2023
Date Signed: 11/11/2023 02:59:28 PM

Document Has Been Signed on 11/11/2023 02:59 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:VNL ARF II LLCFACILITY NUMBER:
361880948
ADMINISTRATOR:MARGARITA CANALESFACILITY TYPE:
735
ADDRESS:1205 W. BOHNERT AVETELEPHONE:
(909) 990-0299
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 3CENSUS: 2DATE:
11/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sydnee Brown, CaregiverTIME COMPLETED:
03:15 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived unannounced to the VNL ARF II, Adult Residential Facility to conduct an Annual Inspection. LPA was greeted by staff member, Sydnee Brown. LPA introduced self and stated purpose of the visit. LPA was granted entry, asked to sign in and have temperature taken. While signing in, LPA observed a COVID station which included PPE, hand sanitizers and information regarding infection control. All made accessible to those who visit the facility. LPA was provided a place to work then completed a walk through of the physical plant. LPA informed the current census is 2. 1 resident away for the weekend.
The facility maintains a partnership with the Inland Regional Center at Level 4I. The facility is approved for 3 ambulatory residents; ages 18 to 59. The facility is operating at the capacity approved by Community Care Licensing (CCL). LPA conducted a general overall inspection, which included, but was not limited to, the following:
Physical Plant: The facility has 3 bedrooms, 1 office, 2 bathrooms, a kitchen, dining area, living room, attached garage, and backyard. Interior and exterior pathways were free of clutter and obstructions. The facility is maintained at a 76 degrees F temperature. LPA inspected resident bedrooms; each room was equipped with required furniture per regulations. Adequate storage space, seating, a mattress with adequate linens and sufficient lighting. LPA observed an adequate supply of linens and towels stored in built in hallway cabinet. LPA inspected resident bathrooms; bathrooms were neat and orderly and included operational appliances. Each bathroom also included adequate hand hygiene supplies. LPA tested the water temperature at the kitchen faucet, which tested within regulation between 102 and 105 degrees F. The facility is equipped with fully charged fire extinguishers and functional smoke detectors and carbon monoxide alarms. Fire extinguisher last inspected August 2023. LPA informed fire drills occur once a month. Last fire drill took place October 2023. Posters such as; resident personal rights, the CCL complaint poster, staff schedule and roster, food menus, house rules and disaster/evacuation plans were posted in a common area.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 11/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/11/2023
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VNL ARF II LLC
FACILITY NUMBER: 361880948
VISIT DATE: 11/11/2023
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Cleaning supplies, toxins, sharps, and other dangerous items were observed in secure locations inaccessible to residents in care. Staff/Resident files and medications are kept secure in the staff office and in secure file cabinets. LPA observed the facility's emergency food and water supply in the kitchen. LPA also observed first aid kits made readily available. There are no pools, bodies of water, firearms or ammunition on facility grounds.
Yards/Outside: LPA observed the backyard to include a patio with adequate seating. LPA observed the evacuation route was clear. Also, the self latching side gate leading to the front of the facility for evacuation in the event of emergencies.

Overall, the facility is clean, in good repair, and operating in safe conditions for future clients in care. Based on observations, interviews and record reviews no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Facility Representative; signature acknowledges understanding and receipt of report and attachments.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/11/2023
LIC809 (FAS) - (06/04)
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