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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530143
Report Date: 10/25/2023
Date Signed: 10/25/2023 09:46:40 AM

Document Has Been Signed on 10/25/2023 09:46 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:BRIAN SCHWICHTENBERG ARFFACILITY NUMBER:
365530143
ADMINISTRATOR:SCHWICHTENBERG, BRIANFACILITY TYPE:
735
ADDRESS:18930 BEAR VALLEY ROADTELEPHONE:
(951) 295-6430
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 4CENSUS: 4DATE:
10/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Brian Schwichtenberg- LicenseeTIME COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA) Michelle Echeverria , arrived at Brian Schwichtenberg, to conduct an announced Pre-Licensing visit for a change of ownership (CHOW). LPA was greeted by Licensee, Brian Schwichtenberg. LPA introduced self and stated purpose of the visit. CHOW application was submitted on 04/27/23 for 4 ARF Ambulatory clients. Fire Safety Inspection clearance was granted for 4 Ambulatory clients. LPA toured the facility inside and outside and observed the following:

Structure: Facility is a one story house with four client bedrooms, one staff bedroom with bathroom, one client bathroom, living room, dining area, kitchen, pantry, backyard and an attached two car garage.

Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house.

Bedrooms: Each client bedroom accommodates ambulatory clients only. All bedrooms have the required bedding and furniture, such as, clean mattresses/linen, nightstands, dressers, chairs, and lighting.

Bathrooms: The client bathroom has a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap.

Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives, sharps, detergent and chemicals are locked and inaccessible to clients. There was a pantry stocked with non-perishable food and perishable food found in the refrigerator. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. Water tested in the kitchen faucet measured at 113 degrees fahrenheit. Laundry has a functional washer and dryer located inside the garage.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: BRIAN SCHWICHTENBERG ARF
FACILITY NUMBER: 365530143
VISIT DATE: 10/25/2023
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Living/Family room: There was a furnished living room with one enclosed fireplace, and tv observed.

Linens and Hygiene Supplies: An adequate supply of linens and hygiene supplies stored in a closet.

Yards/Outside: Patio furniture, self-latching handle fencing on the right side of the house that leads into the backyard. There is no swimming pool or bodies of water observed. All outdoor pathways were free of obstructions.

Emergency Phone Numbers, and Exit Plan: CCL complaint poster, house rules, personal rights and Emergency and Disaster Plan were observed posted in the dining room.

General items: The smoke and carbon monoxide detectors were tested and are operable. There was fully charged fire extinguisher observed. Client/Staff records stored in staff bedroom. First Aid kit with required components, and locked area for medication storage was observed. LPA observed that the facility does not have a telephone for clients use.

Pre-Licensing is incomplete and the following deficiency requires to be resolved by 10/26/2023:

An active land line and working telephone.


An exit interview was conducted, and this report was discussed and provided to Licensee, Brian Schwichtenberg.


SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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