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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401612
Report Date: 01/06/2023
Date Signed: 01/06/2023 11:14:25 AM

Document Has Been Signed on 01/06/2023 11:14 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:BROTHERS HOME HEALTH CARE, INC.FACILITY NUMBER:
366401612
ADMINISTRATOR:MARLIA, DOMINIC J.FACILITY TYPE:
735
ADDRESS:240 W. HAWTHORNE STREETTELEPHONE:
(909) 586-5797
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 6CENSUS: 6DATE:
01/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dominic Marlia, AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Brother's Home Health Care to conduct a Case Management visit for health and safety. Additionally to confirm that the exposed wiring observed on a previous visit had in fact been addressed. LPA introduced self and stated purpose of the visit. LPA was greeted and invited inside by staff member. LPA signed in and had temperature taken.

Administrator Dominic Marlia approached LPA and introduced himself. Administrator showed LPA the recessed lighting and light bulbs have been installed. As well as the wiring for the fire alarm. A red colored cover was placed and wire was no longer observed. LPA was then provided a place to work. LPA walked through facility a second time. Residents currently in day program at time of visit.

An exit interview was conducted where this report (LIC809) was discussed and provided to Administrator Dominic Marlia.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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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