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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530027
Report Date: 08/14/2024
Date Signed: 08/14/2024 11:03:27 AM

Document Has Been Signed on 08/14/2024 11:03 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:VALLEY HOME IIFACILITY NUMBER:
365530027
ADMINISTRATOR/
DIRECTOR:		MIGUEL, CRISELDAFACILITY TYPE:
735
ADDRESS:1256 MORRISON DRIVETELEPHONE:
(909) 894-3653
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 4CENSUS: 4DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Artemio DirigeTIME VISIT/
INSPECTION COMPLETED:
11:05 AM
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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 Administrator, Artemio Dirige, and discussed the purpose of the visit. During today's visit, (3) clients were present, and one client was attending Day Program. The facility is an Adult Residential facility with a license capacity of (4) and a current census (4). LPA conducted an overall inspection, which included, but was not limited to, the following:

Operation/Physical Plant: The facility maintains an emergency disaster plan, a current disaster drill record and surety bond on file. The facility has 24 hour/7 days a week care staff. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor activity space for clients in care. The facility is equipped with operating carbon monoxide alarms, laundry equipment, and telephone service. Client bedrooms were equipped with beds, nightstands, chairs, storage space, sufficient linen and lighting. Client bathroom toilets, hand washing basins and showers were operating in safe conditions. The hot water in client bathrooms tested at 119 degrees F. Sharps and toxins were kept locked and stored away from food areas.

Food Service: The facility’s dining areas, kitchen, and dishware utilized by clients were maintained clean. The facility has sufficient non-perishable and perishable food for number of clients in care. Refrigerator and freezer were maintained within regulation.

Health Related Services: The facility maintains records of client medications and medications are centrally stored in a locked cabinet.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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: VALLEY HOME II
FACILITY NUMBER: 365530027
VISIT DATE: 08/14/2024
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Personnel/Client Records: Staff records reviewed had health screenings, criminal record clearances, first aid/CPR training certifications, and job training. Client records reviewed had admission agreements, medical assessments, needs and service plans, and personal/incidental logs.

Technical advisories were issued but no deficiencies were cited during today’s visit. An exit interview was conducted, where this report was discussed and a copy was provided to the Administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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