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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402043
Report Date: 11/27/2023
Date Signed: 11/27/2023 11:56:54 AM

Document Has Been Signed on 11/27/2023 11:56 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:FIRST STEP INDEPENDENT LIVING PROGRAM, INC.FACILITY NUMBER:
366402043
ADMINISTRATOR:CLIFFORD-HOBBS, CARRIEFACILITY TYPE:
775
ADDRESS:8880 BENSON AVE #103/105/107TELEPHONE:
(909) 949-1780
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 45CENSUS: 25DATE:
11/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Claudia Barajas, Day Program Mgr. & Rachel Steward, Area DirectorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the First Step Independent Living Adult Day Program unannounced to conduct the facility’s Annual Inspection. LPA walked in, introduced self and stated the purpose of the visit. LPA was greeted and invited inside the facility by Day Program Director, Claudia Barajas. LPA was provided a space to work, given a tour of the facility and provided staff and resident files for review.

LPA was informed the current census is 25 and there are currently ten, (10) staff on duty. The facility is comprised of three bathrooms, one changing room, medication area, exercise room, multipurpose rooms, kitchen, locker room, game rooms and several offices for staff use. The facility was initially licensed in November of 1997; approved capacity of 45 non-ambulatory individuals. The facility also maintains vendorship with the Inland Regional Center.

Accompanied by Day Program Director, LPA made the following observations during the facility tour:

Physical Plant: Interior and exterior pathways throughout the facility were free of clutter and unobstructed. Facility was maintained in comfortable temperature throughout the building. There are fire extinguishers in various locations throughout the building. All fire extinguishers last inspected November 2023. Day Program Manager reports the facility conducts fire and disaster drills on a monthly basis. Evacuation Maps were posted in prominent places throughout the building.

LPA observed three restrooms; which all contained adequate amounts of hand hygiene and paper supplies. Each restroom included secure cabinets for incontinent supplies, personal protective, (PPE) and cleaning solutions. LPA observed that outlets throughout the facility to have protective covers for safety.

LPA tested water temperature in the bathrooms. Water temperature was measured between 105 degrees and 120 degrees Fahrenheit; within regulation.

Please see LIC809-C

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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: FIRST STEP INDEPENDENT LIVING PROGRAM, INC.
FACILITY NUMBER: 366402043
VISIT DATE: 11/27/2023
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LPA observed informational posters for resident rights, Long Term Care Ombudsman, labor laws LET-US-KNOW and Infection Control and licensing forms posted in prominent places throughout the facility. All cleaning supplies, toxins, sharps, and other dangerous items were observed in secure areas inaccessible to individuals in care. The facility employs it’s own Licensed Vocational Nurse, (LVN) LVN informed and showed LPA how the medication cart is securely maintained in the medication management area. LPA observed all medical supplies and records to be secure and organized.

Food Service: LPA was informed that the facility provides snacks and cooking classes to individuals. The facilities kitchen was observed to be neat and orderly. The facility offers individuals a variety of snacks such as: pudding, fruit juice, crackers and apple sauce. Sufficient amounts for individuals in care. LPA observed a readily available first aid kit near the front entrance.



Records: LPA reviewed individual files for admission agreements, updated medical assessment, individual program plans and needs and services plans and found that all individuals’ records included documentation per regulation requirements. LPA reviewed staff files and found that each contained up to date First Aid/CPR certification, criminal/fingerprint/backgrounds record clearances, training, and health screenings per regulation.

Overall, LPA observed that the facility is neat, orderly, in good repair, and operating in safe conditions for residents in care.

Based on observations, interviews and record reviews no deficiencies will be cited per Title 22, California Code of Regulations. A copy of this report was read/reviewed with Facility Representative; signature acknowledges understanding and receipt of report and attachments.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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