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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530018
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:35:39 PM

Document Has Been Signed on 08/08/2024 12:35 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:ONENESS CARE HOMEFACILITY NUMBER:
365530018
ADMINISTRATOR/
DIRECTOR:		MARIA LUISA N TALLAFACILITY TYPE:
735
ADDRESS:7743 AROSIA DRIVETELEPHONE:
(909) 784-0000
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 4CENSUS: 0DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Charanjit DhaliwalTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 08/08/2024 at 10:50 AM, Licensing Program Analysts (LPA) Melody Brown and Becky Mann made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPAs Brown and Mann met with Charanjit Dhaliwal, a family member of the Licensee and was granted entry to the facility. At the time of the visit there was no staff present, and no clients present. The facility is a four (4) bedroom, two (2) and 1/2, bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is an Adult Residential Facility (ARF) home and no information available if the facility has been vendorized by Inland Regional Center (IRC). Licensed capacity is (4), current census is zero (0). LPAs Brown and Mann conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility currently has no clients in care. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 70 degrees Fahrenheit. LPAs Brown and Mann inspected future client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathrooms to be at 88 degrees Fahrenheit . Technical Violation issued. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms. The home is currently being utilized as residential home by the Licensee's family while waiting on placement of clients.

Emergency Disaster plan was observed. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible. There was a designated storage space for client/staff files. LPAs were informed of empty medication closet where medication will be potentially stored and inaccessible to clients. Overall, the facility is clean, in good repair, and operating in safe conditions.

Food Service: LPA observed seven (7) days non-perishable and two (2) days perishable food supply. Facility has a variety of food available. Dishes, cups, and utensils were also stored properly.

*** Continuation in LIC809C ***

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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 16
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ONENESS CARE HOME
FACILITY NUMBER: 365530018
VISIT DATE: 08/08/2024
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Care & Supervision: Facility currently has no clients in care. Administrator at the facility have criminal record clearance through the department.

Record Review: LPAs Brown and Mann observed designated Administrator for the facility has an active Administrator Certification per documents review. Also, LPAs Brown reviewed two (2) staff files for criminal record clearance, and health screenings. Medications were not audited as the facility currently has no clients.

In addition, LPAs Brown and Mann observed the facility not having a working telephone service at the facility as required. Technical Violation will be issued. Lastly, LPAs Brown and Mann noted that the facility does not have the required Infection Control Plan. Technical Violation will be issued.

Based on the observations made during today’s visit, Technical Violations (LIC9102TV) and Technical Advisory Notes (LIC9102TA) were issued per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Charanjit Dhaliwal.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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