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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530145
Report Date: 01/25/2024
Date Signed: 01/25/2024 10:22:02 AM

Document Has Been Signed on 01/25/2024 10:22 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:
01/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Peter Alcocer, Administrator & Michael Trujillo, LicenseeTIME COMPLETED:
10:30 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Summerset Horizon on an announced visit to confirm that corrections that were noted in the initial visit were addressed. LPA introduced self and stated purpose of the visit. LPA was greeted and granted entry by Peter Alcocer, Administrator & Michael Trujillo, Licensee.

During today's visit LPA was provided a brief tour and observed the following:
  • Secure cabinetry for chemicals, medications, facility records and sharps in the kitchen. - LPA observed that cabinetry in the kitchen was made secure for the facility to maintain medications and cleaning supplies.
  • Pathway in the backyard was cleared to allow individuals to exit freely the facility in case of an emergency.
  • No posting made - due to oxygen tanks being removed from the residence.
  • Secure hot tub/jacuzzi in backyard.- LPA observed that two, (2) security mechanisms have been added to the hot tub to secure the top of the hot tub. LPA informed the mechanism requires a key to unlock.
  • Secure private individual's medications near kitchen.- LPA observed that the medications have been removed and placed in a secure location inaccessible to unauthorized individuals.
  • Install non-slip grip materials and handrails in resident restroom.- LPA observed that handrails and non-slip grip materials added to the restroom to aide in the prevention of falls.


COMP III was completed during the initial visit. Pre-Licensing corrections have been resolved. Pre-Licensing is now complete. and ready for licensure. An exit interview was completed where this report was reviewed discussed and provided to facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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