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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401612
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:05:52 PM

Document Has Been Signed on 12/04/2024 12:05 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BROTHERS HOME HEALTH CARE, INC.FACILITY NUMBER:
366401612
ADMINISTRATOR/
DIRECTOR:		MARLIA, DOMINIC J.FACILITY TYPE:
735
ADDRESS:240 W. HAWTHORNE STREETTELEPHONE:
(909) 586-5797
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 6CENSUS: 0DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Elia Marlia, Administrator TIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst, LaVette Farlow, (LPA) arrived at the Brother's Home Health Care, Inc. Adult Residential Facility to conduct the Annual Inspection. LPA knocked on the door and was greeted and invited inside the facility by Administrator, Elia Marlia. LPA introduced self and stated the purpose of the visit, then provided a space to work. Administrator, Elia Marlia accompanied LPA Farlow on a tour of the facility, inside and outside, and observed the following:

Facility: The facility, is approved for a capacity of 6 residents, current census is four (4). All four (4) resident are away at the day program. Two, (2) of which can be ambulatory and four, (4) non-ambulatory. Also approved for the hearing impaired. The facility also maintains partnership with the Inland Regional Center; designated level L3. The facility is operating at the capacity and in the conditions approved by Community Care Licensing (CCL).

Physical Plant: The facility's temperatures were observed to be comfortable at 69 degrees. The facility has sufficient lighting provided by various lamps, lighting and night-lights throughout the facility. The facility is equipped with adequate smoke alarms, carbon monoxide detectors and fire extinguishers which were tested and found operable. The facility's fire extinguisher was observed fully charged and last inspected March 6, 2024. Administrator reports that the facility conducts fire drills every month or nothing less than every quarter. Last fire/disaster drill conducted October 2024. LPA observed 4 resident rooms. Each room included adequate seating, sufficient lighting with storage space. Each resident room also contained a backpack of emergency supplies. The facility has 2 resident restrooms. Each bathroom was equipped with adequate amounts of hand soap and paper towels, proper lighting, labeled and separately stored hygiene supplies. Each shower/bathtub included non-slip grip materials and handrails. The facility have a separate staff bathroom. The facility dining, living rooms and den all included adequate seating, lighting and activity materials for residents in care. Hallway closets held extra linens, towels, hygiene supplies.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: BROTHERS HOME HEALTH CARE, INC.
FACILITY NUMBER: 366401612
VISIT DATE: 12/04/2024
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Food Service: Located in the rear of the facility, LPA observed adequate amounts of non perishable food and supplies for the number of residents in care. The facility also maintains three, (3) refrigerators to maintain the facility's food supplies. Sufficient amounts of food and beverages were observed inside as well. The kitchen contained properly storage for its utensils, cups, dishware and pots and pans. Chemicals and sharp objects are kept secure under the kitchen sink inaccessible to residents in care. Emergency water supplies are also kept in the rear of the facility.

Care & Supervision: Facility maintains sufficient care staff; who assist residents 24 hours and 7 days a week.

Record Review and Resident/Staff Files: LPA reviewed administrator and three (3) Care Provider Staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. LPA reviewed three (3) client files for admission agreements, updated physician reports, and needs and services plans. P & I funds were counted at random and matched with the ledger. LPA observed that the residents' medication is centrally stored in a secure cabinets; which is also where the first aid kit and additional supplies can be found. Centrally Stored Medication Log. LPA Farlow did not observe any medication abnormalities. Medication was audited and matched with MARS. LPA reviewed facility's file for fire drills, infection control plan, and emergency disaster plan. LPA observed that the facility did not have a infection control plan available for review. A technical violation issued.
Administration: Disaster Plan, Ombudsman poster, Administrator Certificate, Personal Rights and facility license are posted in the hallway of the facility. Emergency Disaster Plan is current.

No deficiencies were cited during this inspection. One technical violation issued for not having a infection control plan available. A exit interview was conducted and a copy of this report LIC809, LIC809C and LIC9102TV was provided to Administrator/Licensee Elia Marlia.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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