<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881177
Report Date: 04/18/2022
Date Signed: 04/18/2022 12:38:22 PM

Document Has Been Signed on 04/18/2022 12:38 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:AMETHYST BEHAVIORAL HEALTH, LLCFACILITY NUMBER:
361881177
ADMINISTRATOR:RICHARDSON, SANDEEFACILITY TYPE:
772
ADDRESS:921,923,925 TRIBUNE STREETTELEPHONE:
(909) 809-9293
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 12CENSUS: 0DATE:
04/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sandee RichardsonTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Javier Prieto conducted a pre-licensing inspection with Director Sandee Richardson. The inspection was conducted in person with Covid-19 restrictions.

The facility is a three (3) building 12 capacity, which are all ambulatory. Each building is equipped with a bathroom, living room and kitchen. A fire clearance was conducted on 08/25/2021 and is approved for 12 ambulatory residents. Bedrooms are furnished with bed, night stand, dresser and chair. Bedrooms have adequate lighting for residents’ use. The facility has linens, and towels and a sufficient amount of hygiene products for residents. Fire extinguisher was present and fully charged. The kitchens were observed to have dishes, silverware, pots, and pans. Cleaning supplies are locked and stored in kitchen area. Staff and resident files will be locked in cabinets. The medications locked and stored in a locked cabinet. A first aid kit was present and observed to be complete. Smoke detector and carbon monoxide detectors were inspected by Redlands Fire Department. The backyard was observed to be fully fenced and had a covered patio with table and chairs for resident's comfort. Documents required are posted in public view were observed to be present. During today's inspection, no corrections were observed or required. The COMP III orientation was conducted during today's visit.

An exit interview was conducted, and a copy of this report was given to MS Richardson for her review and signature
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1