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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881064
Report Date: 11/03/2022
Date Signed: 11/03/2022 02:56:38 PM

Document Has Been Signed on 11/03/2022 02:56 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:REM CALIFORNIA LLC - JOSHUAFACILITY NUMBER:
361881064
ADMINISTRATOR:JAMES-BONILLA,OLIVIAFACILITY TYPE:
735
ADDRESS:9327 JOSHUA ROADTELEPHONE:
(760) 956-7477
CITY:OAK HILLSSTATE: CAZIP CODE:
92344
CAPACITY: 4CENSUS: DATE:
11/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cynthia Diaz, Administrator & Anna Vilchiz, Program Dir.TIME COMPLETED:
02:55 PM
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LPA Amber Coleman (LPA Coleman) and LPA Anna Bueno (LPA Bueno) arrived at the REM California, LLC Facility for an unannounced Case Management visit based on an incident report received on 10/27/2022. Staff Member greeted LPAs at the door and invited LPA's inside. LPA's signed in and discussed the purpose of the visit. Staff member contacted Administrator who arrived later during the visit. The facility was observed to be cleanly and orderly.

Incident Report indicated that a staff member (S1) was witnessed making an inappropriate comment to a client.

Client 1 (C1) reported that he and staff joke around a lot and other staff don't like it. At the time of the incident, the client was having a hard time adjusting his clothing and shared this with staff. Staff responded by offering the client a cold shower.

Administrator Cynthia Diaz explained that at this time the staff member, Silvia Rodriguez-Lopez is currently on Administrative Leave. The QI Manager Elizabeth Rojas who is responsible for the facility's in house investigation indicated that the findings are inconclusive right now as the staff member is denying the comment was made and the client is stating that the two of them were only joking. The plan for the staff member involved, is that she will be retrained before returning to work. Administrator provided LPA with a copy of the ongoing trainings for staff which includes "Preventing Abuse, Client Rights, Communications and Customer Service" Retraining will be offered to the staff member involved for Professionalism and Customer Service.

Based on information obtained, no deficiencies will be cited at this time.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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Document is an Amendment of Original Document on 11/16/2022 04:47 PM


Created By: Anna Bueno On 11/03/2022 at 11:49 AM
Link to Parent Document Below:
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: REM CALIFORNIA LLC - JOSHUA
FACILITY NUMBER: 361881064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2022
Section Cited
ILS
000

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Based on information obtained, no deficiencies will be cited at this time.
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Based on information obtained, no deficiencies will be cited at this time.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Anna Bueno
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022


LIC809 (FAS) - (06/04)
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