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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408345
Report Date: 11/01/2023
Date Signed: 11/01/2023 12:37:14 PM

Document Has Been Signed on 11/01/2023 12:37 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:UNLIMITED QUEST INCFACILITY NUMBER:
366408345
ADMINISTRATOR:MOLINA, RUTHIEFACILITY TYPE:
775
ADDRESS:250 S DATE STTELEPHONE:
(909) 421-8753
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 60CENSUS: 35DATE:
11/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:MariaTIME COMPLETED:
12:30 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Unlimited Quest Inc. Adult Day Program unannounced to conduct an Annual Inspection. LPA was greeted by staff who notified the Program Supervisor of LPA visit. LPA met with Maria Perez, Day Program Supervisor, introduced self and stated purpose of the visit. LPA was provided with a space to work and given a walk through of the facility.

A tour of the facility was conducted inside and out of physical plant, the following was observed:
Facility: The facility is approved to provide services for 60 non-ambulatory adults. Maria Perez reports the current census is 35. LPA observed that the facility is operating in the capacity and conditions approved by Community Care Licensing.
Physical Plant: The temperature throughout facility was comfortable. The facility includes 4 bathrooms and 1 changing room. Each bathroom contained sufficient amounts of paper towels, hand soap, trash bins and operational appliances. The facility is equipped with operational smoke alarms, water sprinklers and carbon monoxide detectors. LPA also observed two fully charged fire extinguishers. Each one was last inspected March 2023. Program Supervisor reports, that the facility conducts fire and disaster drills twice a month.

At approximately, 10:25am LPA inspected the facility's patio. The patio included two side gates used for an entering and exiting the patio. LPA attempted to walk through the gate toward the front of the facility and observed that it was locked via deadbolt. LPA approached the gate at the back of the facility (alley way) to be locked as well. Program Supervisor was unable to recall if the Fire Marshall approved of the perimeter gate being locked. Administrator, Rolando Barrajas contacted the facility and reported the facility does not have clearance to lock the perimeter gate. LPA observed Program Supervisor use a key to unlock the gate during the visit. Also agreed that one gate will remain unlocked during business hours.
Please see LIC809-C
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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: UNLIMITED QUEST INC
FACILITY NUMBER: 366408345
VISIT DATE: 11/01/2023
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Food Service: The facility does not provide meals for consumers, but maintains a kitchen area to prepare snacks and store consumer's food. LPA observed that chemicals and toxins are secure in a cabinet under the sink. Sharp objects are secure in staff offices, inaccessible to consumers. The facility maintains adequate emergency supplies of food and water for the clients in case of a disaster or emergency. LPA measured the water temperatures in the facility kitchen; and found that the water temperature ranged between 110 to 117 degrees.
Care & Supervision: Facility has sufficient care staff. Program Supervisor reports that there is one staff member for every 3 consumers. Maintaining a 3:1 ratio. Additional cleaning supplies and toxic items are secure in a facility closet; inaccessible to unauthorized individuals. At approximately 10:35am LPA observed a room the facility utilizes as a hair/nail salon. LPA observed upon an activity table stood bottles of nail polish. The room was unoccupied at the time. LPA advised Program Supervisor to secure the nail polish to make it inaccessible to consumers in care. This task was completed during visit. LPA tested the storage cabinets and confirmed that they were locked and secured.
Record Review and Resident/Staff Files: LPA reviewed five staff files and observed that, each staff records/file were complete and current with training and background/fingerprint clearance; per regulation. LPA reviewed 5 consumer files and found that each was complete with current Needs and Services Plans, Physician Reports, and Individual Programs Plans completed by the facility and/or Inland Regional Center.

Based on observations and record reviews, a technical violation will be issued to address the nail polish left out. Also, a deficiency to addressed the locked perimeter gate. An exit interview was conducted where this report was reviewed, discussed and provided to Program Supervisor, Maria Perez.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/01/2023 12:37 PM - It Cannot Be Edited


Created By: Amber Coleman On 11/01/2023 at 12:20 PM
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: UNLIMITED QUEST INC
FACILITY NUMBER: 366408345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82072(6)(7)
82072 Personal Rights
(6) To leave or depart the day program at any time.
(7) Not to be locked in any room, building, or day program site.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above by locking the perimeter gate to the facility; which does not allow consumers to exit the patio freely in case of emergency. Additionally, not having a Fire Marshall clearence to do so. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/02/2023
Plan of Correction
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Program Supervisor, Maria Perez unlocked the perimeter gate during LPA visit. Administrator agrees to complete a statement of understanding of the above regulation by way of a LIC9098. Administrator agrees to submit this form to the Community Care Licensing Office within 1 business day.
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:Nedra Brown
LICENSING EVALUATOR NAME:Amber Coleman
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


LIC809 (FAS) - (06/04)
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