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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881137
Report Date: 06/24/2022
Date Signed: 06/24/2022 02:47:02 PM

Document Has Been Signed on 06/24/2022 02:47 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:RADIANTLIZ HOMECAREFACILITY NUMBER:
361881137
ADMINISTRATOR:CALLEJAS, FLORDELIZA P.FACILITY TYPE:
735
ADDRESS:9730 CUPID WAYTELEPHONE:
(909) 771-3880
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 2CENSUS: 0DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Licensee/Administrator Flordeliza CallejasTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melody Brown arrived at the facility 06/24/2022 at 01:15 PM unannounced in order to complete the facility's Annual Inspection. LPA Brown met with Licensee/Administrator Floredeliza Callejas and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed:

Infection Control: LPA Brown went over COVID-19 best practices for infection control and prevention with Licensee/Administrator Callejas. The facility submitted their Mitigation Plan today, 06/24/2022.

LPA Brown observed the facility to not having Covid-19 signages throughout the facility for cough etiquette, and social distancing and LPA Brown requested Licensee/Administrator Callejas to post appropriate Covid-19 signages throughout the facility. LPA Brown will be issuing a Technical Assistance Advisory Note during today's inspection for not having Covid-19 signages throughout the facility for cough etiquette and social distancing. Currently, there are no clients at the facility and LPA Brown toured the facility's client bedrooms and bathrooms and observed that both client bathrooms have paper towels and hand soap.

LPA Brown requested to inspect the facility's Personal Protective Equipment (PPE) supply. LPA Brown observed the facility to have a 30-day supply of sanitizer, gloves, masks, and face shields/goggles and isolation gowns. LPA Brown went over the various recommended training for facility staff with Licensee/Administrator Callejas in relation to COVID-19 and informed Licensee/Administrator Callejas that once they have clients, staff needs to be trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing of PPE.

**** Continuation in LIC809C ****

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: RADIANTLIZ HOMECARE
FACILITY NUMBER: 361881137
VISIT DATE: 06/24/2022
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LPA Brown inquired as to if staff have been fit tested for N95 masks, and Licensee/Administrator Callejas informed LPA Brown that all staff have not been fit tested at this time. LPA Brown will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Brown informed Licensee/Administrator Callejas that once the facility will have clients, staff are required to have been fit tested for N95 masks.

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. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and their clients, once they have clients for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor their clients regularly for any changes in condition and to subsequently notify the clients physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses.



During the visit, LPA Brown requested staff vaccination records and on 06/24/2022 at 02:15 PM, LPA Brown observed all staff are vaccinated and boosted. LPA Brown informed Licensee/Administrator Callejas that the facility must update their staff vaccination record at the facility.

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

An exit interview was conducted with Licensee/Administrator Flordeliza Callejas and a copy of this report (LIC 809), LIC9102 TA Advisory Notes were discussed and provided.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC809 (FAS) - (06/04)
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