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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530066
Report Date: 02/10/2025
Date Signed: 02/10/2025 10:52:44 AM

Document Has Been Signed on 02/10/2025 10:52 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:WE SHARE, WE CAREFACILITY NUMBER:
365530066
ADMINISTRATOR/
DIRECTOR:		BRYANT III, WILSON G.FACILITY TYPE:
740
ADDRESS:19196 PINE WAYTELEPHONE:
(760) 810-7059
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 4CENSUS: 0DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Wilson Bryant IIITIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Magda Malcore made a visit to the facility to conduct a required annual inspection. LPA met with Wilson Bryant III, Licensee, and discussed the purpose of the visit.
The facility is a two (2) bedroom, three (3) bathroom with attached garage, Residential Care Facility for the Elderly (RCFE). The facility's license capacity is (4) with a current census of (0) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:
Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water.
Resident’s bedrooms had beds, bed linen, and furniture in good repair. The facility is equipped with carbon monoxide alarms, fire extinguishers, laundry equipment and covered fireplace. The facility had a sufficient supply of linen and towels. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, Personal Rights, disaster evacuation plan and emergency telephone numbers, and house rules. Sharps, disinfectants, and cleaning solutions were kept in a locked closet.
Food Service: Facility kitchen and dining areas are maintained clean. The facility has sufficient plates, cups, utensils, and food storage space.

Care & Supervision: Currently there are no staff or residents in care.

Record Review: The Licensees' Administrator’s certification is current. Currently there are no staff or residents in care to conduct a file review.

Medical Related Services: The facility has a locked closet where medications will be stored. The facility has a complete first aid kit.

Technical assistance notes were issued during today’s visit. An exit interview was conducted where this report was discussed and a copy provided to the Licensee at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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