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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402684
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:54:31 PM

Document Has Been Signed on 11/15/2024 03:54 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:UNLIMITED QUEST INC VFACILITY NUMBER:
366402684
ADMINISTRATOR/
DIRECTOR:		ROSEBOROUGH, BRIDGETFACILITY TYPE:
775
ADDRESS:118 FOOTHILL BLVD #A1/A2/A3/A4TELEPHONE:
(909) 873-8319
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 45CENSUS: 35DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Alyssa Sandoval, Day Program ManagerTIME VISIT/
INSPECTION COMPLETED:
04:02 PM
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Licensing Program Analyst, LaVette Farlow (LPA) arrived at the Unlimited Quest Inc.V Adult Day Program unannounced to conduct an Annual Inspection. LPA was greeted by Program Supervisor, Andreana Hernandez, and granted LPA entry. Program Supervisor notified Day Program Manager, Alyssa Sandoval of LPA's arrival and met with LPA at the front of the facility. LPA introduced self and stated the purpose of the visit. LPA was provided with a space to work and given a walk through of the facility.

A tour of the facility was conducted inside and out of physical plant, the following was observed:
Facility: The facility is approved to provide services for 45 non-ambulatory adults. A capacity increase request was granted 11/4/03. Program Director reported the current census is 35. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing.
Physical Plant: The facility was maintained at a comfortable temperature. The facility includes 4 bathrooms and 1 changing room. LPA measured the water temperature in the bathroom; and observed that temperature ranged between 104.1, 105.0 and 106.5 degrees. Each bathroom contained sufficient amounts of paper towels, hand soap, trash bins and operational appliances. Also, each bathroom was equipped with securable cabinets used to keep incontinent supplies and air freshener. The facility is equipped with operational smoke/fire alarms, water sprinklers and carbon monoxide detectors. LPA also observed four fully charged fire extinguishers. Each one was last inspected January 2024. Program Supervisor reports, that the facility conducts fire drills on a monthly basis; and disaster drills every 6 months. The facility maintains a waiver for outdoor activity space. LPA observed that the outdoor activity space continues to meet requirements. Exterior and Interior pathways were free of clutter and unobstructed.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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: UNLIMITED QUEST INC V
FACILITY NUMBER: 366402684
VISIT DATE: 11/15/2024
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Food Service: The facility does not provide meals for individuals, but maintains a kitchen area to prepare snacks, store individual's food and cooking classes. Sharp objects are kept secure in staff offices inaccessible to individuals. LPA observed that chemicals and toxins are secure in a hallway closet; along with additional infection control supplies. The facility maintains adequate emergency supplies of food and water for the individuals in case of a disaster or emergency. LPA measured the water temperature in the kitchen; and observed that temperature was 112.4 degrees.
Care & Supervision: Facility has sufficient care staff. Program Supervisor reports that the facility staffs' in a 3:1 ratio. One staff member for every 3 individuals.
Record Review and Resident/Staff Files: LPA reviewed four staff files. LPA observed 3 out of four staff records/file were complete and current with training and background/fingerprint clearance; per regulation. One staff file was missing current CPR certificate a technical violations will be issued. LPA reviewed two individuals' files and found that each was complete with current Needs and Services Plans, Physician Reports, Admission agreement, and Individual Programs Plans completed by the facility and/or Inland Regional Center.

Based on observations and record reviews, technical violations will be issued to address a concern of staff having current CPR certificate on file. An exit interview was conducted where this report was reviewed, discussed and provided to Program Director, Alyssa Sandoval
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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