361881177-3-25-2024-56-AS-MMAE-D3PRMN-20240325130901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 361881177
Report Date: 03/25/2024
Date Signed: 03/25/2024 01:09:12 PM

Document Has Been Signed on 03/25/2024 01:09 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:	AMETHYST BEHAVIORAL HEALTH, LLC		FACILITY NUMBER:	361881177
ADMINISTRATOR:	RICHARDSON, SANDRA		FACILITY TYPE:	772
ADDRESS:	921,923,925 TRIBUNE STREET		TELEPHONE:	(909) 809-9293
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY: 12		CENSUS: 8	DATE:	03/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sandee Richardson		TIME COMPLETED:	01:12 PM

NARRATIVE

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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Sandee Richardson, Chief Administration Officer, and discussed the purpose of the visit. The facility is a Long-Term Social Rehabilitation Facility with a license capacity of (12) and current census of (8) clients. LPA conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: LPA observed indoor and outdoor passageways are kept free of obstruction. The facility has sufficient indoor and shaded outdoor space for client activities. The facility has no swimming pools or similar bodies of water. The facility has sufficient bed linen, towels, personal hygiene products, and infection control supplies. The facility has operating telephone service, carbon monoxide alarms, and laundry equipment. The facility has posted in a common area: Community Care Licensing complaint poster, facility license, evacuation exit plan, client personal rights and client activities. Cleaning supplies and other toxins were kept locked. Client bedrooms were equipped with beds, nightstands, chairs, permanent closets, and sufficient lighting. LPA inspection of three (3) client bathroom reveals; the hot water temperature in house #925's bathroom tested at 124 degrees F; The Chief Administration Officer stated that the water heater will be adjusted. Deficiency cited.

Care & Supervision: The facility has 24 hours a day, 7 days a week, awake direct care staff.

Food Service: The facility has sufficient supply of non-perishable and perishable food. Food is stored a safe and healthful manner. Menus were posted in a common area.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: AMETHYST BEHAVIORAL HEALTH, LLC	FACILITY NUMBER: 361881177
	VISIT DATE: 03/25/2024

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Record Review: Six (6) resident files reviewed included admission agreements, medical assessments, and needs and services plans. Six (6) staff files reviewed included criminal record clearances or exemptions, job training, first aid/CPR training and health screenings.

Medical Related Services: Client medications are labeled and centrally stored in a locked cabinet and room.

Based on observations and record review, a deficiency is being cited per Title 22, of The California Code of Regulations.

This report was reviewed with the Chief Administration Officer and a copy with Appeal Rights was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/25/2024 01:09 PM - It Cannot Be Edited

Created By: Magda Malcore On 03/25/2024 at 12:16 PM

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: AMETHYST BEHAVIORAL HEALTH, LLC	FACILITY NUMBER: 361881177
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

81088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observations, the licensee did not comply with the section cited above by the hot water temperature in house #925's bathroom tested at 124 degrees F; which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/26/2024
	Plan of Correction
1 2 3 4	The Licensee shall submit to the licensing agency documentation of water temperature testing within regulation by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Karen Clemons

LICENSING EVALUATOR NAME:

Magda Malcore

LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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