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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881240
Report Date: 02/14/2022
Date Signed: 02/14/2022 11:12:59 AM

Document Has Been Signed on 02/14/2022 11:12 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BRODIE FAMILY TREATMENT FACILITYFACILITY NUMBER:
361881240
ADMINISTRATOR:BRODIE, WINIFREDFACILITY TYPE:
735
ADDRESS:8939 BOXWOOD AVENUETELEPHONE:
(909) 528-9979
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 3CENSUS: 0DATE:
02/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Winifred BrodieTIME COMPLETED:
11:25 AM
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On 2/14/22 Licensing Program Analyst (LPA) Shaunte Henry conducted an announced visit for the purpose of conducting a pre-licensing inspection. Upon arrival, LPA met with Winifred Brodie. Licensee. On 1/4/22 the Fontana Fire Department approved the facility for 3 ambulatory clients. The facility is a single story structure with 3 bedrooms with 2 bathrooms. There is a COVID-19 mitigation plan on file.

LPA toured the home inside and out. There is a COVID-19 screening station at the front entry. All client are appropriately furnished according to regulations. The LPA observed kitchen, dining room, living room and activity areas. The appliances in the kitchen operate properly. Sharps, cleaners and disinfectants will be kept locked in the kitchen cabinets. The facility is stocked with dishes, glasses, and utensils all in good repair. There are no bodies or water on the property. The facility is stocked with a sufficient amount of personal hygiene supplies, and linens available for clients. The facility is stocked with a 2 day supply of perishable, and a 7 day supply of non-perishable food items. The emergency disaster plan, personal rights and complaint procedures, food menu and daily activities are posted. The facility has a stocked first aid kit. The facility has a laundry room and laundry supplies that will be inaccessible to clients. The facility has a working land line telephone. The medication will be kept inaccessible to clients. Staff and clients files will also be inaccessible. The water temperature was within the regulated range. Fire extinguishers are located throughout the facility in place and are fully charged. There were no deficiencies observed during the inspection. Comp III was completed during the inspection. An exit interview was conducted where this report was provided to Winifred Brodie.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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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