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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530139
Report Date: 03/07/2025
Date Signed: 03/07/2025 11:30:31 AM

Document Has Been Signed on 03/07/2025 11:30 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:BENCHMARK TRANSITIONSFACILITY NUMBER:
365530139
ADMINISTRATOR/
DIRECTOR:		CLARK, MICHELEFACILITY TYPE:
772
ADDRESS:10132 CAMULOS AVETELEPHONE:
(818) 209-5011
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 6CENSUS: 1DATE:
03/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Barbara Kimberling, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Eldin Serrano made an unannounced required annual visit to the facility. LPA was greeted by behavioral health technician (BHT) William Devery and gained access to the home and BHT immediately called the executive director. LPA met with Executive Director Barbara Kimberling and discussed the purpose of the visit. The facility is a Social Rehabilitation Facility (SRF). Licensed capacity of (6) and current census of one (1) client. LPA conducted a general overall inspection, which included, but was not limited to, the following:

Physical Plant: LPA observed indoor and outdoor passageways are kept free of obstructions. The facility has sufficient indoor and shaded outdoor space for client activities. The facility has two side gates with self latching handle that can access the backyard. The facility has a sufficient supply of bed linen, towels, and personal hygiene products for clients in care. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; bedrooms were equipped with beds, nightstands, chairs, lighting, and storage space. LPA inspected client bathrooms; hot water temperatures tested at 105 degrees Fahrenheit. LPA observed in a common area: Community Care Licensing complaint poster, weekly menu, license, facility sketch, activities schedule, emergency telephone numbers and personal rights posters. LPA observed sharps and chemical/toxins were kept locked and inaccessible to clients in care.

Food Service: LPA observed a sufficient supply of non-perishable and perishable food for clients in care. Food was stored in a safe and healthful manner.

Record Review: LPA reviewed one (1) client file for admission agreements, medical assessments, and treatment plan. LPA reviewed (2) staff files for criminal record clearance, trainings, CPR certificates, and health screenings. LPA observed medications were kept in a locked room inaccessible to clients in care. Medications audited were labeled and maintained as prescribed.

No deficiencies were cited during today’s visit. An exit interview was conducted where this report LIC809, was discussed, and copies were provided to Executive Director Barbara Kimberling.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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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