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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530145
Report Date: 12/21/2023
Date Signed: 12/21/2023 11:35:36 AM

Document Has Been Signed on 12/21/2023 11:35 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:SUMMERSET HORIZONFACILITY NUMBER:
365530145
ADMINISTRATOR:ALCOCER, PETERFACILITY TYPE:
735
ADDRESS:2783 WEST SUMMERSET DRIVETELEPHONE:
(714) 448-0533
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 4CENSUS: 0DATE:
12/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Peter AlcocerTIME COMPLETED:
11:30 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Summerset Horizon Property announced to conduct a Pre-Licensing Visit Inspection. LPA met with Peter Alcocer and Michael Trujillo who greeted LPA and invited LPA inside. LPA introduced self and stated purpose of the visit.

Today's pre-licensing inspection is for initial application for an Adult Residential Facility submitted to this agency on 9/6/23. The fire clearance was approved on 11/16/23 for four, (4) ambulatory residents.

The facility has a total of three, (3) resident bedrooms, one, (1) staff room/office, two bathrooms, a kitchen/dining area, a living room, a family room, backyard, and attached garage. LPA and Licensee toured the interior and exterior areas of the facility. The following were inspected:

Client Bedrooms: Two, (2) bedrooms were missing a bed and required furniture. One bedroom included a bed with the required furniture, lighting and adequate storage. The last bedroom is a private bedroom with an attached bathroom.
Client Bathrooms: The bathroom included operable appliances and adequate hand hygiene materials. The bathtub is missing non-slip grip materials on the bathtub floor and hand rail(s) to aid in fall prevention.
Kitchen and Dining Areas: Utensils and dishware were observed to be in good condition for resident use. Kitchen appliances and counter top were in operable conditions. Sharp objects and other dangerous items are designated to be kept in a cabinet under the kitchen sink It was reported that the cleaning supplies/materials, medications and other dangerous items are designated to be kept under the sink and in a kitchen cabinet. The cabinets were missing a way to secure items inside. Administrators agreed to have the cabinetry made secure.
Living Room/ Dining Room: There is adequate seating in the common areas. The facility has operable landline telephone, internet and activities accessible to residents in care.
Laundry Room/Attached Garage: The area is secured by a door from the hallway.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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: SUMMERSET HORIZON
FACILITY NUMBER: 365530145
VISIT DATE: 12/21/2023
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Backyard: There is a covered area with seating. Pathways were not clear from obstructions. LPA and Administrators discussed plan to have the obstructions removed. LPA observed a hot tub/jacuzzi/spa in the backyard. The jacuzzi had a cover/top on the of it. LPA did not observe the top was secured and/or immovable.
A charged fire extinguisher and operating smoke detectors and carbon monoxide alarms were observed and tested at the time of visit. Both found to be operable. LPA did not observe required postings including the visitation polices, emergency/disaster plans, and personal rights. The facility was equipped with a complete first aid kit and manual.

LPA observed that the physical plant is clean, in good repair. The following will need to be addressed before licensing approval:
  • Secure cabinetry for chemicals, medications, facility records and sharps in the kitchen.
  • Clear pathway in backyard.
  • Post Required postings. Also, Oxygen in Use Sign, Evacuation
  • Secure hot tub/jacuzzi in backyard.
  • Secure private individual's medications near kitchen.
  • Install non-slip grip materials and handrails in resident restroom.


LPA completed COMP III with Licensee at the conclusion of the inspection. An exit interview was conducted where this report was discussed and a copy was provided to Michael Trujillo and Peter Alococer.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC809 (FAS) - (06/04)
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