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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530111
Report Date: 06/30/2023
Date Signed: 06/30/2023 03:06:31 PM

Document Has Been Signed on 06/30/2023 03:06 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LA VERNE'S TOUCH 1FACILITY NUMBER:
365530111
ADMINISTRATOR:REYES, ERIKAFACILITY TYPE:
735
ADDRESS:2831 LA MORANDA DRTELEPHONE:
(787) 672-8034
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 4CENSUS: 0DATE:
06/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Searcy and Erika ReyesTIME COMPLETED:
03:15 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the La Verne's Touch Facility for an announced visit to conduct the Pre-Licensing Inspection. LPA introduced self and stated purpose of the visit. LPA was greeted by Searcy Synder, Licensee and Erika Reyes, Administrator and invited inside the facility. LPA was provided a space to set up and work, then provided a tour of the facility inside and out. LPA observed the following:

Application: The application is for an Adult Residential Facility (ARF). Fire clearance has been granted for four (4) ambulatory adult residents. Fire clearance was approved on 4/28/23.

Buildings and Grounds: The home is composed of three (3) bedrooms, two (2) bathrooms, 2 common areas, kitchen, dining room, laundry room, an attached garage and backyard. Interior pathways were unobstructed and free of clutter. Smoke, Fire and Carbon Monoxide alarms were tested and found functional - all hardwired to one another. Fire Extinguishers were observed fully charged and last inspected 4/28/23.
The backyard included adequate spacing for activities and shady seating for residents in care. Exterior pathways were clear and unobstructed. There are no pools or other bodies of water located on premises. Administrator and Licensee report there are no weapons or ammunition kept in the facility.

Resident Rooms - each room included regulated mattress, bed linens, storage, seating, intact window screens and sufficient lighting. Each room also included extra linens and adequate storage space. One room has an attached bathroom. Bathroom appliances in working order and housed adequate paper and hygiene supplies .Bathrooms were observed to have non-slip bath mats available. The water temperature was tested and measured at 125 degrees Fahrenheit, Licensee was able to adjust the water heater decreasing the temperature to regulatory limits. Activity supplies such as board games, connect four, and a Playstation (videogame console) were available for resident use. The facility maintains an internet connection and working landline phone for its residents. The washing machine and dryer were observed in good condition.

Please see LIC809-C
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
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: LA VERNE'S TOUCH 1
FACILITY NUMBER: 365530111
VISIT DATE: 06/30/2023
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Storage and Supplies: Medications will be stored inaccessible to residents in a secure hallway closet. Inside of a secure file cabinet within the closet. Also kept in this closet are emergency supplies, 1st aid kits, staff and resident files and facility files. Cleaning supplies will be stored away in a locked cabinet in the hallway cabinet. Linens, personal hygiene supplies, and equipment are all in good repair and sufficient for approved census.

Food Service: Utensils, dishware and storage space are sufficient for the requested capacity. The refrigerator and stove are in working order and offered a variety of foods to potential residents in care. Sharps will be stored in a secured lock box on the kitchen counter.

Forms: The following forms were observed to be posted at the home: Emergency Disaster Plan (LIC 610D), Personal Rights, Facility Sketch/Evacuation Plans in each room. Labor laws and licensing information.

No deficiencies were observed during inspection. LPA will inform the Centralized Applications Bureau the home is ready to be licensed. An exit interview was conducted. This report was reviewed, discussed then provided to Searcy Synder.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2023
LIC809 (FAS) - (06/04)
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