366400061-5-30-2023-56-AS-MMAE-CSBQ6M-20230530115346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366400061
Report Date: 05/30/2023
Date Signed: 05/30/2023 11:53:59 AM

Document Has Been Signed on 05/30/2023 11:53 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:	JAMES HOME		FACILITY NUMBER:	366400061
ADMINISTRATOR:	JAMES-TOWNSEND, JANETTE		FACILITY TYPE:	735
ADDRESS:	19626 PERRY		TELEPHONE:	(909) 873-0873
CITY:	RIALTO	STATE: CA	ZIP CODE:	92377
CAPACITY: 6		CENSUS: 4	DATE:	05/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Vernall Townsend, Administrator		TIME COMPLETED:	12:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analysts (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Vernall Townsend, Administrator and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF), license capacity of (6) with a current census of (4). The facility has 4 client bedrooms, 1 staff bedroom, 2 bathrooms, kitchen/dining area, living room, family room and attached garage. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. Facility Living room, dining room, and family room furniture is in good repair and sufficient for clients in care. The facility has sufficient lighting and is maintained at a comfortable temperature of 73 degrees F.

LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food for number of clients in care. Facility food is stored in a safe and healthful manner. Facility has a weekly menu posted in the dining room area. Kitchen hot water temperature tested within regulation at 110 degrees F. Sharps, toxins, chemicals are kept locked and inaccessible to clients in care.

LPA inspected client bedrooms. Bedrooms are equipped with required furniture such as: mattresses, nightstands and storage space. Bedrooms have sufficient linen and lighting. No bedrooms are shared.

LPA inspected the bathrooms. Bathrooms were operating in a safe and sanitary conditions. Client bathroom equipped with handrails and non-slip mats. The hot water temperature tested within regulation at 106 degrees F.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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: JAMES HOME	FACILITY NUMBER: 366400061
	VISIT DATE: 05/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguisher. Posters such as complaint reporting, facility sketch, facility license, disaster plan and emergency numbers were posted in a common area. Laundry equipment maintained in good condition. Toxins and chemicals kept in a locked cabinet in garage. Extra linen and toileting supplies stored in hallway cabinet. Extra personal hygiene supplies stored in locked cabinet in dining area.

LPA observed medications are kept in a safe and locked cabinet inaccessible to clients in care. Facility has complete first aid kits and emergency supplies.

LPA reviewed (4) client files for admission agreements, needs and service reports and updated physician reports, all had the required documentation. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings, all had the required documentation. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, California Code of Regulations.

An exit interview was conducted, where this report (LIC809) was discussed and a copy of report with appeal rights was provided to Administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2