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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366406754
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:20:56 PM

Document Has Been Signed on 09/26/2024 02:20 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:WINTER PLACEFACILITY NUMBER:
366406754
ADMINISTRATOR/
DIRECTOR:		NEAL, DAVIDFACILITY TYPE:
735
ADDRESS:11375 WINTER PLACETELEPHONE:
(760) 246-6465
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY: 8CENSUS: 4DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Myra WilliamsTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with House Manager Myra Williams and discussed the purpose of the visit.

The facility is a two-story, Adult Residential facility with a license capacity of (8) and a current census (4). LPA conducted an overall inspection, which included, but was not limited to, the following:

Operation/Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pools or similar bodies of water. The facility has sufficient indoor and outdoor activity space for clients in care. The facility is equipped with smoke and carbon monoxide alarms, fully charged fire extinguisher, laundry equipment, and telephone service. Client bedrooms were equipped with beds, bed linen, nightstands, chairs, and lighting. Client bathroom equipment was fully operational. The hot water in client bathrooms tested at 109 degrees F. Sharps, disinfectants and cleaning supplies were kept locked and inaccessible to clients in care. The facility has 24-hour care staff with criminal record clearances.

Food Service: The facility’s kitchen area was maintained clean and clutter free. The facility has sufficient non-perishable and perishable food for number of clients in care. The facility’s refrigerators and freezers were operating in a healthful manner.

Health Related Services: The facility maintains records of client medications and medications are centrally stored in a locked closet.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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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: WINTER PLACE
FACILITY NUMBER: 366406754
VISIT DATE: 09/26/2024
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Personnel/Client Records: Staff records were reviewed had health screenings, criminal record clearances, and first aid/CPR training certification. Client records were reviewed for admission agreements, medical assessments, needs and service plans.

Technical advisories were issued and no deficiencies were cited during today’s visit. An exit interview was conducted, where this report was discussed and a copy was provided to the House Manager at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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