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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881064
Report Date: 11/29/2023
Date Signed: 11/29/2023 11:30:50 AM

Document Has Been Signed on 11/29/2023 11:30 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:
11/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 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 11/16/23. 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 11/14/23 client 1 (C1) reported to temporary area director (S1) who was visiting the facility that staff (S2) has forced (C1) to leave the living room and go back to their room on many occasions. Client 2 (C2) also reported to (S1) that (S2) has forced (C2) to leave the living room and go back to their room and prohibit (C2) from doing house chores which (C2) enjoys.

During today's visit, LPA met with Program Director in the office to discuss the incident and surrounding events. LPA interviewed staff and reviewed records. During interviews, it was discovered that other staff have confirmed the allegations against (S2), (S2) has been placed on administrative leave and client rights training is pending for 12/08/2023. Internal facility investigation is still pending and a decision is being determined for (S2) employment status with the facility.

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: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2023
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 11/29/2023 11:30 AM - It Cannot Be Edited


Created By: Michelle Echeverria On 11/29/2023 at 11:04 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: 11/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2023
Section Cited
CCR
80072(a)(2)

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80072(a)(2) Personal Rights
(a) Except for children’s residential facilities, each....limited to, the following:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Program Director stated that client rights training is scheduled for 12/08/2023. Program Director will submit a copy of training attendance sheet to LPA via email by POC due date.
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Based on interviews and records review, the program director did not comply with the section cited above by not ensuring that clients were accorded safe, healthful and comfortable accommodations 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: 11/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023


LIC809 (FAS) - (06/04)
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