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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881048
Report Date: 01/20/2023
Date Signed: 01/20/2023 11:42:08 AM


Document Has Been Signed on 01/20/2023 11:42 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AQUA RIDGE OF MONTCLAIRFACILITY NUMBER:
361881048
ADMINISTRATOR:MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:9631 MONTE VISTA AVETELEPHONE:
(909) 483-2782
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:115CENSUS: 33DATE:
01/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Monique Del JuncoTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Paola Guerrero 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. LPA met with Facility Administrator Monique Del Junco and was granted entry to the facility. LPA toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Monique. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients and properly caring for clients with COVID-19 positive results and/or exposures. 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 proper use and disposal of PPE. The entrance of the facility has a check in process for visitors that includes a temperature check and a symptom check. The clients have hand sanitizer available to them throughout the facility, and the bathrooms were stocked with hand soap and paper towels. The facility has postings throughout the facility for proper cough etiquette, proper hand washing procedure, and/or social distancing guidelines. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, located on second floor in facility storage room. The facility has a full thirty (30) day supply of PPE items such as gloves, face shields, gowns, disinfectant, surgical masks, N95 masks, and hand sanitizer. All clients and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Monique Del Junco.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola GuerreroTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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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