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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530114
Report Date: 03/22/2024
Date Signed: 03/22/2024 11:23:19 AM

Document Has Been Signed on 03/22/2024 11:23 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ABLEWAY ADULT RESIDENTIAL FACILITY LLCFACILITY NUMBER:
365530114
ADMINISTRATOR:SIMS, JOEFACILITY TYPE:
735
ADDRESS:17929 STEVENS STTELEPHONE:
(424) 233-5881
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 6CENSUS: 0DATE:
03/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Joe SimsTIME COMPLETED:
11:24 AM
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Licensing Program Analyst (LPA) Anna Fannell conducted an announced visit for a pre-licensing inspection. LPA Bueno identified herself to applicant Joe Sims and informed Mr. Sims of the purpose of the visit.

The facility is currently applying for licensed Adult Residential Facility. The facility has been granted a fire clearance on 08/10/2023 by the San Bernardino County Fire Protection District for a total capacity of 6 ambulatory clients.

LPA Bueno and Mr. Sims toured the interior and exterior of the facility. The facility has four client bedrooms, two bathrooms, kitchen, a living/sitting room, dining and activity area, and backyard. The facility has no bodies of water. A covered patio has ample seating and recreational outdoor activities. The facility has a working phone and internet services for client use. LPA observed charged fire extinguisher while interconnected smoke alarms carbon monoxide detectors were tested and found to be in working order. The facility keeps a complete first aid kit. A locked centralized storage area for medications and client and staff files was observed.

The following were observed of the physical plant:
Client Bedrooms: LPA observed all bedrooms to have the required bedding and furniture, such as, mattresses/linen, sufficient storage space, chairs, and lighting.
Client Bathrooms: LPA observed all bathrooms and fixtures are kept in sanitary conditions.
Dining Area and Kitchen: LPA inspected the kitchen and found dishes, glasses, and utensils were in good working order. LPA observed appropriate food provisions.
Activity Area and Living Room: LPA observed adequate seating in the common areas. The facility had a supply of activities and reading materials for individuals served.

Items for correction: Prior to LPA Fannell providing Centralized Applications Bureau (CAB) of passing the
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Fannell
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ABLEWAY ADULT RESIDENTIAL FACILITY LLC
FACILITY NUMBER: 365530114
VISIT DATE: 03/22/2024
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pre-Licensing inspection, Applicant Sims shall make the following corrections and/or adjustments to the facility:
    • Move personal items not intended for client use out of the facility
    • Maintain a first aid manual and appropriate emergency provisions
    • Replace hallway bathroom screen
    • Lock the garage to prevent access from inside the home (recommended but not required for secured/locked storage for poisons and cleaning agents)

Analyst will conduct a subsequent correction visit when above corrections have been made. Component 3 will be covered during the subsequent visit. An exit interview was conducted with applicant Joe Sims and a copy of the report was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Fannell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC809 (FAS) - (06/04)
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