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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530114
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:05:27 AM

Document Has Been Signed on 04/04/2024 11:05 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/
DIRECTOR:		SIMS, JOEFACILITY TYPE:
735
ADDRESS:17929 STEVENS STTELEPHONE:
(424) 233-5881
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 6CENSUS: 0DATE:
04/04/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:Joe SimsTIME VISIT/
INSPECTION COMPLETED:
11:07 AM
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Licensing Program Analysts (LPAs) Javier Prieto and Anna Bueno made an announced visit to the facility for the purpose of verifying corrections from the initial Pre-Licensing inspection on March 22, 2024. LPAs were greeted and granted entry by licensee Joe Sims. LPAs observed the following:

Personal items not intended for client have been removed out of the facility.
A first aid manual and emergency provisions are present in the garage.
Hallway bathroom screen has been replaced.
A stand alone locked cabinet is used for storage for poisons and cleaning agents.

COMP III was conducted during today's visit. Pre-licensing is now complete. An exit interview was conducted and a copy of this report provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Fannell
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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