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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881216
Report Date: 02/21/2025
Date Signed: 02/21/2025 11:37:20 AM

Document Has Been Signed on 02/21/2025 11:37 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:DYNELL'S GUEST HOME #1FACILITY NUMBER:
361881216
ADMINISTRATOR/
DIRECTOR:		ROBINSON, CHARLESFACILITY TYPE:
735
ADDRESS:12423 FELIPE DRIVETELEPHONE:
(760) 955-9393
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 6CENSUS: 1DATE:
02/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:51 AM
MET WITH:Charles Robinson-AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:52 AM
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Licensing Program Analyst (LPA) Michelle Echeverria arrived at the facility unannounced to conduct a required Annual visit. LPA was greeted by Administrator, Charles Robinson. LPA toured the facility inside and outside with the Administrator. LPA observed that there is currently (1) client admitted to the facility.

The facility has 5 bedrooms (4 clients, 1 staff), 2 bathrooms (1 clients, 1 staff), a kitchen, dining area, living room, attached garage, and backyard. The facility is a specialized home vendorized by Inland Regional Center. LPA conducted a general overall inspection, which included, but was not limited to the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature 76 degrees Fahrenheit. LPA inspected clients bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. An adequate supply of linens stored in a cabinet in the main hallway of the residence. LPA inspected clients bathroom; bathroom was clean and appliances were operating appropriately. LPA tested the water temperature in the bathroom faucet, which tested within regulation at 110.5 degrees Fahrenheit. The facility is equipped with operating fire extinguisher, smoke detectors and carbon monoxide alarms. Posters such as; the personal rights, the CCL complaint poster, and disaster plans were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept locked. There was a designated locked storage space for client/staff files, first aid kit and medication. The facility had emergency supplies for the clients. There are no pools, bodies of water, firearms or ammunition. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Yards/Outside:
One shaded patio furniture for outdoor seating along with (3) locked sheds used for storage. Side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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: DYNELL'S GUEST HOME #1
FACILITY NUMBER: 361881216
VISIT DATE: 02/21/2025
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Food Service: Non-perishable and perishable food supply is sufficient for clients in care. Dishes, cups, and utensils were also stored properly. Emergency food and water were also observed.

Record Review: LPA reviewed the staff and Administrator's files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA reviewed the client's file for admission agreement, updated physician report, and needs and services plan. P & I funds and medication was audited and appeared to be managed appropriately. The facility last conducted a disaster drill on February 5, 2025. LPA observed that the Infection Control Plan was not reviewed/updated annually (2/1/24). Technical violation issued. LPA observed that the Emergency Disaster Plan was not reviewed/updated annually (1/5/24). Technical violation issued.

No deficiencies and two technical violations were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C and LIC9102TV were discussed and copies were provided to Administrator, Charles Robinson.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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