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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408320
Report Date: 10/12/2022
Date Signed: 10/12/2022 02:59:53 PM

Document Has Been Signed on 10/12/2022 02:59 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:LMB CARE HOMEFACILITY NUMBER:
366408320
ADMINISTRATOR:BRANDON DELGADOFACILITY TYPE:
735
ADDRESS:1125 WEST "J" STREETTELEPHONE:
(909) 460-9372
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 6CENSUS: DATE:
10/12/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Licensee Marilyn DelgadoTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility on 10/10/2022 at 1:27 PM to conduct a health and safety check. LPA was not able to gain entry to the home as no one was at the facility. LPA left the area returned to the facility at 2:01 PM on 10/10/2022 and found that the home was still empty, with no staff to open the facility.
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Licensing Program Analyst (LPA) Anna Bueno returned to the facility unannounced on this day at 2:07 PM to conduct a health and safety visit. LPA met with Licensee Marilyn Delgado who was informed of the reason for today's visit and allowed LPA entry to the home.

LPA Bueno and Licensee Delgado toured the facility inside and out. The facility was equipped with sufficient food supplies, at least two (2) days supply of perishable food and seven (7) days supply of nonperishable food items. Cleaning supplies and sharps were kept safe and secured. Client bedrooms had the required furniture and sufficient lighting. The facility has a charged fire extinguisher and operational smoke alarm and carbon monoxide detector. All areas of the facility, including client bedrooms and bathrooms, appeared to have appropriate furnishings, are clean, and in good repair.

LPA Bueno observed that the facility appeared to be meeting operational requirements. LPA observed that all utilities and appliances were functioning properly. LPA observed no apparent health and safety risks at the time of visit.

Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted where this report was discussed with Licensee Delgado and a copy was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2022
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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