366403998-5-16-2023-56-AS-MMAE-CRVQ3X-20230516114927

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366403998
Report Date: 05/16/2023
Date Signed: 05/16/2023 11:49:41 AM

Document Has Been Signed on 05/16/2023 11:49 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:	SCHONEVELD HOME		FACILITY NUMBER:	366403998
ADMINISTRATOR:	THERESA SOTO		FACILITY TYPE:	735
ADDRESS:	3457 SOUTH WRANGLER PLACE		TELEPHONE:	(909) 923-7527
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91761
CAPACITY: 4		CENSUS: 4	DATE:	05/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Evelyn Green, Administrator		TIME COMPLETED:	11:55 AM

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On 5/16/23, Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Evelyn Green, Administrator and discussed the purpose of the visit. At the time of the visit there were no clients at the facility, clients were at a Day program. The Administrator and two (2) staff were at the facility.

The facility is an Adult Residential Facility (ARF) with 4 bedrooms, 2 bathrooms in the home. LPA observed kitchen/dining area, family room area, and a attached garage. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture, lighting, and maintained at 73 degrees F.

LPA inspected the kitchen. Facility has sufficient nonperishable and perishable food for number of client in care. Facility has a variety of food available for clients, and a weekly menu posted on the kitchen cabinet. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked in kitchen drawers, inaccessible to clients in care.

LPA inspected four (4) client bedrooms. The bedrooms are equipped with required furniture in good condition and sufficient lighting.

LPA inspected two (2) bathrooms. Bathrooms are operating in a safe and sanitary condition. The hot water temperature tested within regulation at 108 and 115 degrees F. Bathrooms showers are equipped with hand rails.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SCHONEVELD HOME	FACILITY NUMBER: 366403998
	VISIT DATE: 05/16/2023

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LPA observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguisher. Posters such as personal rights and the disaster plan were posted in a common area. Cleaning supplies, toxins items are kept locked and inaccessible to clients in care.

LPA observed medications are kept in a locked cabinet inaccessible to clients in care. Medications were audited at random, medications are current and dispensed appropriately as prescribed. Facility has complete first aid kits and emergency supplies.

LPA reviewed four (4) client files for admission agreements, updated physician reports, and needs and services plans. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.

Overall, the facility is clean, has sufficient care staff coverage 24 hours a day and operating in safe conditions for clients in care.

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

An exit interview was conducted where this report (LIC809/LIC809C) was discussed, and a copy was provided to the administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC809 (FAS) - (06/04)

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