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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881188
Report Date: 01/29/2024
Date Signed: 01/29/2024 12:55:27 PM

Document Has Been Signed on 01/29/2024 12:55 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:SPOELSTRA LLC DBA VOICE - REDLANDFACILITY NUMBER:
361881188
ADMINISTRATOR:YANES, TONIFACILITY TYPE:
775
ADDRESS:461 TENNESSEE ST STE R.TELEPHONE:
(909) 307-1600
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: 60CENSUS: 45DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Toni Yanes - Program DirectorTIME COMPLETED:
01:00 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 Toni Yanes, Program Director, and discussed the purpose of the visit.
The facility is an Adult Day Program and certified vendor for Inland Regional Center (IRC). The facility has a license capacity of 60 with a current census of 45 clients. The facility is operating within ratio. LPA conducted an overall inspection, which included, but was not limited to the following:
The facility passageways are clear and free of obstructions. The facility has (4) areas designated for client activities and recreation. The facility does provide snacks for the clients. The facility has sufficient lighting and furniture in good repair. Client rest areas and bathrooms are maintained clean and odor free. The hot water temperature in clients bathrooms are maintained at 111 degrees F. The facility is equipped with carbon monoxide detectors and telephone service. The facility has posted in a common area personal rights, facility license, evacuation points sketch and emergency telephone numbers. Cleaning supplies and other toxic items were kept locked and inaccessible to clients in care. Client medications are centrally stored and kept in a locked cabinet. Facility has a designated storage space for client and staff files. The facility's last fire drill was conducted on 1/24/24. LPA observed (4) client files to be complete. LPA review of four (4) staff files reveal staff #1 (S1) did not have a record of tuberculosis results on file. Deficiency cited. The facility did not maintain a current, written disaster and mass casualty plan of action on file. Deficiency cited.

Based on LPA observations and record review, deficiencies were cited per Title 22, Division 6 of The California Code of Regulations.

An exit interview was conducted where reports LIC809, LIC809-D, and LIC9102 were discussed. Copies of the reports with Appeal Rights were provided to the Program Director at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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Document Has Been Signed on 01/29/2024 12:55 PM - It Cannot Be Edited


Created By: Magda Malcore On 01/29/2024 at 12:01 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: SPOELSTRA LLC DBA VOICE - REDLAND
FACILITY NUMBER: 361881188

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Type B
Section Cited
CCR
82066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on LPA record review, the licensee did not comply with the section cited above by not maintaining tuberculosis results for staff #1 (S1) on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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The licensee shall submit to the licensing agency proof of a complete health screening with tuberculosis results for staff #1 by POC due date
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: 01/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 01/29/2024 12:55 PM - It Cannot Be Edited


Created By: Magda Malcore On 01/29/2024 at 12:01 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: SPOELSTRA LLC DBA VOICE - REDLAND
FACILITY NUMBER: 361881188

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Type B
Section Cited
CCR
82023(a)
Disaster and Mass Casualty Plan
(a) Each licensee shall have and maintain on file a current, written disaster and mass casualty plan of action.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on LPA record review, the licensee did not comply with the section cited above by not maintaining a written disaster and mass casualty plan on file for review; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/23/2024
Plan of Correction
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4
The Licensee shall submit to the Licensing Agency a disaster and mass casualty plan by POC due date.
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: 01/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2024


LIC809 (FAS) - (06/04)
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