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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366406690
Report Date: 06/29/2022
Date Signed: 06/29/2022 11:45:46 AM

Document Has Been Signed on 06/29/2022 11:45 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:MOUNTAIN OF PROMISEFACILITY NUMBER:
366406690
ADMINISTRATOR:KAY F. NILESFACILITY TYPE:
775
ADDRESS:1381 MANZANITA WAYTELEPHONE:
(909) 337-0219
CITY:DEER LODGE PARKSTATE: CAZIP CODE:
92352
CAPACITY: 15CENSUS: 0DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Cathy Yturralde - office managerTIME COMPLETED:
11:47 AM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced visit to the day program to conduct an annual inspection, with an emphasis on infection control. LPA met with office manager Cathy Yturralde and was explained the reason for today's visit. Yturralde confirmed that there are currently no confirmed and/or suspected Covid-19 cases in the facility.

The facility is currently providing in-person and remote services for clients. There were no clients in the facility during today's visit.

LPA Bueno and Yturralde toured the facility and made observations regarding the infection control measures that the day program is implementing. Yturralde confirmed that universal symptom screening is conducted prior to transporting the client to the facility. LPA observed single entry point and a separate door exclusively used to exit the building. The day program has an adequate amount of hand hygiene, disinfectants and personal protective equipment. The day program has a plan in place to monitor participants regularly for any changes in condition. Assigned staff will clean and disinfect highly touched surfaces at the end of each day while a deep cleaning of the facility is scheduled once a week. Continued weekly routine testing for staff is still observed.

LPA observed that the facility appeared to be meeting operational requirements. LPA observed that all utilities actively used and appliances in working order. Office manager confirmed that the combination smoke alarm and carbon monoxide detector is maintained and tested regularly. A charged fire extinguisher was last inspected on 5/6/2022.

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 a copy of this report was provided to Ms. Yturralde
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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