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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366403248
Report Date: 02/03/2025
Date Signed: 02/03/2025 01:40:18 PM

Document Has Been Signed on 02/03/2025 01:40 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:COLE VOCATIONAL SERVICES BIG BEARFACILITY NUMBER:
366403248
ADMINISTRATOR/
DIRECTOR:		PENDINGFACILITY TYPE:
775
ADDRESS:40627 BIG BEAR BLVDTELEPHONE:
(909) 878-2272
CITY:BIG BEAR LAKESTATE: CAZIP CODE:
92315
CAPACITY: 45CENSUS: 26DATE:
02/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Program Manager, Sheila NorrisTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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On 02/03/2025 at 9:50AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility for the required annual inspection. LPA identified self to day Program Manager (PM) Sheila Norris who was advised of the purpose of the visit. The facility is currently licensed as an Adult Day Program and has 25 clients present.

LPA Small and PM Norris toured the facility. The facility has no bodies of water. LPA and PM observed that client access doors are unlocked and free of obstruction. The facility has a working telephone for use. The facility fire extinguishers were last inspected on 10/25/24. The fire alarms are maintained and tested by a third party service provider. During today's visit, the carbon monoxide detector was tested and found to be operable. The last fire and earthquake drill was conducted on 1/16/25.

The following were observed of the physical plant:
LPA and PM Norris observed all activity rooms were kept clean and free from odors. Hazards were kept safe and secured from clients. Activity rooms had appropriate seating and tables for activities for all clients served. LPA and PM observed clients participating in activities while maintaining appropriate staffing within each group. LPA observed a kitchen with a refrigerator and several storage cabinets. The facility provides snacks. Restrooms were clean and toilet paper, paper towels and soap are present in each. Three bathrooms were inspected by LPA Small and PM Norris. A complete first aid kit was observed. The facility does not maintain any medication nor does it use manual restraints. LPA observed a spray bottle filled with cleaning solution in an unlocked cabinet in one of the client restrooms on the west side of the building. A deficiency was cited. Other toxins, cleaning agents, and other supplies are kept locked and secured.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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Document Has Been Signed on 02/03/2025 01:40 PM - It Cannot Be Edited


Created By: Renese Howell-Small On 02/03/2025 at 12:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: COLE VOCATIONAL SERVICES BIG BEAR
FACILITY NUMBER: 366403248

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above by not ensuring that one (1) sprary bottle that contained a cleaning solution was not locked or inaccessible to clients, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/04/2025
Plan of Correction
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The Program Director removed the spray bottle that a cleaning solution and placed it in a locked cabinet during the visit and will submit proof of staff training regarding cleaning solutions by the plan of correction due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Karen Clemons
LICENSING EVALUATOR NAME:Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2025


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: COLE VOCATIONAL SERVICES BIG BEAR
FACILITY NUMBER: 366403248
VISIT DATE: 02/03/2025
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The following records were reviewed:
LPA Small inspected client files and found that the required documentation including clients' rights, admissions agreement, and Individual Service Plan (ISP) were complete. LPA reviewed staff files which contained background clearance, First Aid/CPR certification, and required training.

An exit interview was conducted where this report LIC809, LIC809C, LIC809D and Appeal Rights were discussed and a copy provided to PM Norris at the conclusion of the inspection.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2025
LIC809 (FAS) - (06/04)
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