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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881000
Report Date: 09/07/2022
Date Signed: 09/07/2022 10:00:37 AM


Document Has Been Signed on 09/07/2022 10:00 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:LOMBARDY SENIOR CARE, LLCFACILITY NUMBER:
361881000
ADMINISTRATOR:SOTERO CHANDLER RAMAS IIIFACILITY TYPE:
740
ADDRESS:4095 LOMBARDY AVETELEPHONE:
(909) 248-1524
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:6CENSUS: 6DATE:
09/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Chandler Ramas - AdministratorTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced visit to the facility for a required annual inspection, with emphasis on infection control. LPA met with staff Carlos Montoya Administrator Chandler Ramas was phoned by staff and arrived during this visit.

LPA toured the facility inside and out. The facility has no bodies of water. The facility has a charged fire extinguisher, operating smoke alarms, and carbon monoxide detector. Cleaning supplies, medications, and sharps were kept in a safe and locked place. Staff office is located in the garage, where cleaning supplies are kept as well. Medications were kept in a locked cabinet. Sharps were stored in a secured area. Resident bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items.

LPAs observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, residents, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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