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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402735
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:50:24 PM


Document Has Been Signed on 01/30/2024 03:50 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:RAMADA RANCHFACILITY NUMBER:
366402735
ADMINISTRATOR:EMERSON, DIANE L.FACILITY TYPE:
740
ADDRESS:35859 RAMADA LANETELEPHONE:
(909) 797-7822
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:6CENSUS: 3DATE:
01/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Amanda Chastain- House ManagerTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced case management visit during complaint control number 56-AS-20240122161217. LPA met with Administrative Assistant Amanda Chastain and explained the reason for the visit.

During today's visit, LPA observed a hole in the ceiling in the dinning room. The area near the hole has damaged dry wall, dry wall is missing, paint is damaged, and paint is missing from the wall. The window seal near the window is also damaged, has holes, and is missing drywall. The window seal and the wall near the hole are both discolored with possible water damage. LPA took pictures of the damage.

Based on observations today, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.



An exit interview was conducted, and this report was discussed and provided to Administrative Assistant Amanda Chastain, along with a copy of the appeal rights.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan GardnerTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 01/30/2024 03:50 PM - It Cannot Be Edited

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: RAMADA RANCH
FACILITY NUMBER: 366402735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
CCR
87303(a)

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87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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The licensee has agreed to read regulation 87303 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to hire a licensed contractor to repair the ceiling, the wall, and the window seal in the dinning room.
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Based on observation the licensee did not comply with the section cited above evidenced by having a hole in the dining room ceiling and by having a damaged window seal in the same area which poses a potential health, safety, or personal rights risk to persons in care.
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The licensee has agreed to send LPA an invoice from a licensed contractor and send picture proof of the repairs by the POC due date. The POC is due by 2/16/2024.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan GardnerTELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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