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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402684
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:52:24 AM

Document Has Been Signed on 11/06/2025 11:52 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 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: 52DATE:
11/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Alyssa Sandoval, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:00 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 DSP Staff, Linda Macik, and granted LPA entry. Linda notified the Day Program Director Alyssa Sandoval of LPA's arrival. 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 52. 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 of 69 degrees Fahrenheit. The facility includes 4 bathrooms and 1 changing room, kitchen, music room, sensory room, salon, fitness room, computer room, art and craft room and patio. LPA measured the water temperature in the bathroom; and observed that temperature ranged between 107.1, 106.2, 105, 106.9, and 106.7 degrees Fahrenheit. 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 November 2025. Program Director 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.
NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Lavette Farlow
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 11/06/2025
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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 within regulations.
Care & Supervision: Facility has sufficient care staff. Program Director 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 four (4) out of four (4) staff records/file were complete and current with training and background/fingerprint clearance; per regulation. LPA observed one staff file was missing a health screen, but LPA did review that staffs TB test results. LPA advised Alyssa to conduct a review of all files for completeness. LPA reviewed four (4) 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, one technical advisory was issued to address a concern of staff having current health screening in file. An exit interview was conducted where this report was reviewed, discussed and provided to Program Director, Alyssa Sandoval
NAME OF LICENSING PROGRAM MANAGER: Nedra Brown
NAME OF LICENSING PROGRAM ANALYST: Lavette Farlow
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC809 (FAS) - (06/04)
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