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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402794
Report Date: 06/13/2024
Date Signed: 06/13/2024 10:55:24 AM

Document Has Been Signed on 06/13/2024 10:55 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:ANTHESIS SENIOR ADULT CENTER (RASS)FACILITY NUMBER:
366402794
ADMINISTRATOR/
DIRECTOR:		LUCY YAMAS CORTEZFACILITY TYPE:
775
ADDRESS:4669 HOLT BLVD.TELEPHONE:
(909) 399-3449
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 44CENSUS: 40DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Lucy Yamas CortezTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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 Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA was welcomed and was granted entry to the facility. The facility is a four (4) bathroom facility, with a kitchen/dining area, and activity room space. The Facility is an Adult Day Program (ADP), licensed capacity is forty-four (44) current census forty (40). LPA was accompanied by Administrator Lucy Yamas Cortez conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. LPA observed sufficient furniture, activities and lighting throughout the facility. The hot water temperature tested within regulation at 120 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated office for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Food Service: Clients bring their own lunch. Program provides snacks to client based on allergies or special food diets.

Care & Supervision: Facility has sufficient care staff for coverage.

Record Review: LPA reviewed six (6) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed (6) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administration Lucy Yamas Cortez

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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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