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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366405698
Report Date: 08/09/2023
Date Signed: 08/09/2023 12:05:31 PM

Document Has Been Signed on 08/09/2023 12:05 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:INNOVATIVE BUSINESS PARTNERSHIPS, INC.FACILITY NUMBER:
366405698
ADMINISTRATOR:THERESE M. KRAGNESSFACILITY TYPE:
775
ADDRESS:17191 JASMINE STREETTELEPHONE:
(760) 243-1400
CITY:VICTORVILLESTATE: CAZIP CODE:
92307
CAPACITY: 90CENSUS: 17DATE:
08/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Administrator Therese M. KragnessTIME COMPLETED:
12:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Therese M. Kragness and was granted entry to the facility. At the time of the visit there was eight (8) staff, and seventeen (17) clients present. The facility is an Adult Day Program (ADP) facility. Licensed capacity is (90) current census (17). LPA was accompanied by Administrator Therese M. Kragness to 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. The facility is maintained at a comfortable temperature. 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. There was a designated storage space for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions. LPA observed no carbon monoxide detector in the facility. Administrator stated the facility has not been required for a carbon monoxide detector. Administrator provided LPA with a fire clearance from July 27, 2023 and Adult Day Program Key Indicator Tool Kit (July 2011) from CCL website.

Food Service: At Day Program, clients are responsible to bring their own lunch. Facility has emergency snacks, and emergency water available for clients. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Day Program has sufficient care staff coverage for Monday through Friday. All staff members working in the facility have criminal recorded clearance through the department.

Record Review: LPA reviewed eight (8) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance,and health screenings.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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Document Has Been Signed on 08/09/2023 12:05 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Mary Rico On 08/09/2023 at 11:05 AM
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: INNOVATIVE BUSINESS PARTNERSHIPS, INC.
FACILITY NUMBER: 366405698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type A
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations no carbon monoxide detectors in the facility. Administrator stated the facility never had a carbon monoxide detectors and have never been required.
POC Due Date: 08/10/2023
Plan of Correction
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Facility shall purchase carbon monoxide detector(s) and submit proof to licensing via email with proof of receipt and photo of installed carbon monoxide detector by POC date above.
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:Efren Malagon
LICENSING EVALUATOR NAME:Mary Rico
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023


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: INNOVATIVE BUSINESS PARTNERSHIPS, INC.
FACILITY NUMBER: 366405698
VISIT DATE: 08/09/2023
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Based on the observations made during today’s visit, one (1) deficiency were cited per Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. An exit interview was conducted, and this report (LIC809) was discussed along with the Appeal Rights and provided to Administrator Therese M. Kragness.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
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