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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401188
Report Date: 06/26/2023
Date Signed: 06/26/2023 11:27:35 AM

Document Has Been Signed on 06/26/2023 11:27 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:SALEM CHRISTIAN HOMES, INC.-"CASA PUENTE"FACILITY NUMBER:
366401188
ADMINISTRATOR:SORIA, ANGELINAFACILITY TYPE:
735
ADDRESS:2904 DEL NORTE PLACETELEPHONE:
(909) 923-1961
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 6CENSUS: 4DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Latisha Anderson- Facility ManagerTIME COMPLETED:
11:40 AM
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 Licensing Program Analyst (LPA) Victoria Chitgian arrived unannounced to conduct a visit to the facility for a required annual inspection. Facility is an Adult Residential Facility licensed for six (6) ambulatory clients. LPA met with Administrator Latisha Anderson at the facility.
LPA conducted a walk-through the facility's interior and exterior. The facility has a charged fire extinguisher, operating fire alarm systems, and carbon monoxide detectors. Outdoor and indoor passageways were kept free of obstruction. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. The facility menu was available for review and included nutritious options. Sharps were stored in a secured area in the kitchen. LPA toured the client bedrooms. The client bedrooms had functional lighting and required furniture. The facility had a supply of additional linen and extra hygiene items for the clients. The facility had a complete first aid kit available and the last disaster drill was conducted on 6/18/2023. Cleaning supplies were locked away. Centrally stored medications were kept in a safe and locked cabinet. LPA toured the bathroom. Utilities were tested and operating as required. Hot water temperature was measured was found within required limits at 109 degrees Fahrenheit. LPA observed that the outside of the facility lacked a shaded area. Administrator stated to put in a work order for shade canopy to be installed. Technical Assistance issued. The facility does not have bodies of water.
LPA reviewed staff and client files. Staff files had the required documentation including a health screening report and first aid/CPR certification. Client files had the required documentation including an admission's agreement, updated physician's reports, and appraisal/needs & services plans. LPA inspected client medications. Medications were dispensed appropriately according to the physician's orders. Facility has secured each consumer’s personal property and cash resources. Sufficient staff are employed and present in the facility to meet the needs of the consumers in care. All required postings were visible in a common area.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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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: SALEM CHRISTIAN HOMES, INC.-"CASA PUENTE"
FACILITY NUMBER: 366401188
VISIT DATE: 06/26/2023
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No deficiencies were issued during this visit. One(1) Technical Assistance issued. An exit interview was conducted where this report LIC 809 and LIC 9102 was discussed and provided to the Administrator Latisha Anderson at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC809 (FAS) - (06/04)
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