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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880991
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:48:37 PM

Document Has Been Signed on 12/01/2021 02:48 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
RIVERSIDE, CA 92507
FACILITY NAME:BEST CARE GUEST HOMEFACILITY NUMBER:
361880991
ADMINISTRATOR:GARCIA, RICHIEFACILITY TYPE:
740
ADDRESS:817 S OAKS AVENUETELEPHONE:
(909) 638-8871
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 14CENSUS: 13DATE:
12/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Richie Garcia, AdministratorTIME COMPLETED:
02:50 PM
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Licensing Program Analysts Rohit Lama and Anna Bueno made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPAs identified themselves to Administrator, Richie Garcia, and discussed the purpose of the visit. Prior to entry, Administrator required LPAs to get a temperature check, screen for symptoms, ensured that LPAs were masked, and sign-in. Administrator stated that all staff and residents were fully vaccinated and had their booster shots, and that there were no recent positive COVID test results nor were there any individuals currently with COVID symptoms.

Inspection Tool was utilized, Mitigation plan was reviewed. Facility was further inspected and no deficiencies were noted.


During the inspection, LPA Lama interviewed the Administrator pertaining to the facility's infection control measures and other health and safety concerns. LPA Lama observed necessary signs posted in the facility, including signs related to COVID-19, which were in accordance with the Department's guidelines. The Administrator stated that the facility is equipped with sufficient PPE, hand hygiene supplies, and sufficient cleaning/disinfecting provisions. LPAs observed that the facility staff were wearing face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2021
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
RIVERSIDE, CA 92507
FACILITY NAME: BEST CARE GUEST HOME
FACILITY NUMBER: 361880991
VISIT DATE: 12/01/2021
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The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation of residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms.

Based on interviews and 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 Richie Garcia at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
LIC809 (FAS) - (06/04)
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