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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366400061
Report Date: 06/21/2022
Date Signed: 06/21/2022 01:33:36 PM

Document Has Been Signed on 06/21/2022 01:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:JAMES HOMEFACILITY NUMBER:
366400061
ADMINISTRATOR:JAMES-TOWNSEND, JANETTEFACILITY TYPE:
735
ADDRESS:19626 PERRYTELEPHONE:
(909) 873-0873
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 6CENSUS: 4DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Vernall Townsend - AdministratorTIME COMPLETED:
01:36 PM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced annual required visit, with an emphasis on infection control. LPA met two care providers who were advised of the nature of today's visit and was granted entry to the facility. Staff verified that there are currently no active and/or suspected Covid-19 cases in this home. Administrator arrived shortly.

LPA toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, interconnected smoke alarms, and carbon monoxide detectors. Cleaning supplies and sharps were kept in locked cabinets. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The client bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items.

LPA observed one central entry point and routine symptom screening has been initiated at entry for all staff, clients, and visitors. LPA observed hand sanitizers and cleaning wipes throughout the facility. All residents have at least a 30 day supply of medications.

LPA observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, the facility is meeting operational requirements. No deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Technical advisories were issued to remind staff the importance of being properly fitted with a face covering. An exit interview was conducted where this report was discussed and a copy of this report was also provided to Mr. Townsend at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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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