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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366400732
Report Date: 10/19/2023
Date Signed: 10/19/2023 03:16:17 PM

Document Has Been Signed on 10/19/2023 03:16 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INC.FACILITY NUMBER:
366400732
ADMINISTRATOR:CAROL SANTA CRUZFACILITY TYPE:
775
ADDRESS:1910 ORANGETREE LANE SUITE 340TELEPHONE:
(909) 335-3030
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 45CENSUS: 34DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lucy Esquero, Program DirectorTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced required annual visit to the facility. LPA met with Lucy Esquero, Program Director and discussed the purpose of the visit. The facility is an Adult Day Program with a license capacity of (45) and current census of (34) clients. LPA conducted an overall inspection, which included, but was not limited to the following:

The facility passageways are clear and free of obstructions. The facility has (6) designated areas for client activities. Client activities include arts and crafts, listening to music, gardening, bowling, and table top activities. LPA inspected client bathrooms; Bathroom equipment is operating in safe and sanitary conditions. The hot water temperature in the bathrooms tested within regulation between 105- and 106 degrees F. LPA inspected facility kitchen which was clean and free of odors. The facility has operating telephone service. LPA observed posted in a common area: emergency evacuation plans and telephone numbers, personal rights and Community Care Licensing complaint poster. An earthquake drill was conducted on 9/25/23 and again today 10/19/23. Facility has a complete first aid kit and sufficient personal protective equipment. Disinfectants, cleaning supplies and toxins were kept locked and inaccessible to clients. LPA reviewed (3) staff files for criminal record clearances or exemptions, training, and health screenings. Staff 1 (S1) had an incomplete health screening on file. Deficiency cited. LPA reviewed (3) client files for emergency contacts, admissions’ agreements, medical assessments and needs and service plans. Client 1 (C1) had an incomplete health screening on file.

Deficiencies were cited during today's visit and a plan of correction was discussed with the Program Director.An exit interview was conducted, and a copy of the licensing reports with appeal rights were provided to the Program Director at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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 4
Document Has Been Signed on 10/19/2023 03:16 PM - It Cannot Be Edited


Created By: Magda Malcore On 10/19/2023 at 02:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 366400732

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA file review, the licensee did not comply with the section cited above by staff's incomplete health screening/results, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
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Licensee/Program Director shall submit to the licensing agency proof of examination results by POC date
Type B
Section Cited
CCR
82069(b)(1)
Client Medical Assessments
(b) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA file review, the licensee did not comply with the section cited above by Client did not have examination results on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2023
Plan of Correction
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Licensee/Program Director shall submit to the licensing agency proof of examination results by POC date
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Clemons
LICENSING EVALUATOR NAME:Magda Malcore
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4