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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402043
Report Date: 11/06/2024
Date Signed: 11/06/2024 01:59:27 PM

Document Has Been Signed on 11/06/2024 01:59 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:FIRST STEP INDEPENDENT LIVING PROGRAM, INC.FACILITY NUMBER:
366402043
ADMINISTRATOR/
DIRECTOR:
CLIFFORD-HOBBS, CARRIEFACILITY TYPE:
775
ADDRESS:8880 BENSON AVE #103/105/107TELEPHONE:
(909) 949-1780
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 45CENSUS: 28DATE:
11/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Claudia Barajas, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Program Manager Claudia Barajas, and discussed the purpose of the visit.

The facility is an Adult Day Program with a current census of 28 clients. During today's visit, there were 10 direct care staff present. LPAs conducted an overall inspection, which included, but was not limited to the following:

The facility's passageways were clear and free of obstructions. The facility has six (6) main areas designated for client activities. The facility has sufficient supply of arts supplies, board games, sensory activity items for client use. Client restrooms were odor free and operating in sanitary conditions, hot water temperature measured at 111 degrees Fahrenheit. Cleaning solutions stored in a supply closet kept locked and stored away from clients in care. The facility has operating smoke alarm and carbon monoxide alarms. The facility has posted in a common area: facility license, facility evacuation sketch, Community Care Licensing complaint poster, and an emergency disaster plan with emergency telephone numbers. Five (5) staff files were observed to be complete and included criminal record clearances. Five (5) client files were observed to be complete.

Based on observations and record review, no deficiencies will be cited per Title 22 of the California Code of Regulations. An exit interview was conducted where the licensing reports were discussed with the Program Manager. A copy of the reports was provided to the Program Manager at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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