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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881064
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:33:17 AM

Document Has Been Signed on 10/03/2023 11:33 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: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: 4DATE:
10/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Christina Diaz- Program DirectorTIME COMPLETED:
11:36 AM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Echeverria arrived at the facility unannounced to conduct a Case Management Visit. This case management visit is in response to a Special Incident Report (SIR) submitted to the Community Care Licensing Office on 09/20/23. LPA was greeted and met by Staff Julissa Saenz and Crystelle Saenz at the front door. LPA introduced self and stated purpose of the visit.

On 09/18/23 Staff (S1) and Staff (S2) discovered that Client (C1) had $7 in wallet after counting, when there should have been $201.00.

During today's visit, LPA met with Program Director in the office to discuss the incident and surrounding events. LPA did a health and safety check, interviewed clients and staff and reviewed records. During interviews, it was discovered that another similar incident had occurred on 05/13/23 where Client (C2) was missing $277.00. Client (C2) received $300.00 from family on 05/07/23 and (S3) verified it yet it was not recorded. LPA discovered through interviews and records review that the facility failed to safeguard the clients cash and maintain accurate records.

Deficiency was issued during this visit. An exit interview was conducted where this report LIC809, LIC809D and appeal rights were, reviewed, discussed and then provided to Program Director, Christina Diaz.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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Document Has Been Signed on 10/03/2023 11:33 AM - It Cannot Be Edited


Created By: Michelle Echeverria On 10/03/2023 at 11:16 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
, 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: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
80026(b)

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80026(b) Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(b) If such a client is accepted for or maintained in care, his/her cash... specified in (c) through (n) below. This requirement is not met as evidenced by:
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Program Director stated that she will hold a training meeting with staff reviewing regulation 80026(b) and submit proof to LPA via email by POC due date. Program Director stated that all cash, debit/credit transactions will be safeguarded and logged with receipts on hand.
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Based on observation, interviews, and records review, the program director did not comply with the section cited above by not safeguarding the clients cash resources and maintaining accurate records which poses a potential health, safety or personal rights risk to clients in care.
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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:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023


LIC809 (FAS) - (06/04)
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