<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408345
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:18:14 PM

Document Has Been Signed on 11/15/2024 12:18 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:UNLIMITED QUEST INCFACILITY NUMBER:
366408345
ADMINISTRATOR/
DIRECTOR:		MOLINA, RUTHIEFACILITY TYPE:
775
ADDRESS:250 S DATE STTELEPHONE:
(909) 421-8753
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 60CENSUS: 27DATE:
11/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:54 AM
MET WITH:Rolando Barajas, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst, LaVette Farlow, (LPA) arrived at the Unlimited Quest Inc. Adult Day Program unannounced to conduct an Annual Inspection. LPA was greeted by Day Program Manager, Rolando Barajas. LPA, introduced self and stated the 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. Rolando Barajas reports the current census is 27. 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, 1 changing room. One restroom is being repaired, and out of service. Each bathroom contained sufficient amounts of paper towels, hand soap, trash bins and operational appliances. The hot water in 3 of the 4 bathrooms inspected was not maintained within regulation. Bathroom #1 tested at 92.5 degrees F, Bathroom #2 at 86.1 and bathroom #4 tested at 86.4 degrees F. A deficiency cited. 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 in 2024. Day Program Manager reports, that the facility conducts fire and disaster drills monthly.

LPA inspected the facility's patio. The patio included two side gates used for an entering and exiting the patio. LPA observed that the front gate towards the parking lot toward the front of the facility was locked and inaccessible to enter and exit. LPA approached the gate at the back of the facility (alley way) to be unlocked. Rolando state that one gate remain unlocked during business hours.
Please see LIC809-C
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: UNLIMITED QUEST INC
FACILITY NUMBER: 366408345
VISIT DATE: 11/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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. 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 did not test the water temperature in the facility kitchen; Rolando did immediately request that maintenance come to repair the water heater and adjust the temperature. Maintenance did arrive before my departure, unfortunately repairs were not completed.
Care & Supervision: Facility has sufficient care staff. Day Program Manager 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. LPA observed a room the facility utilizes as a hair/nail salon, a music room, game room, arts and craft room and a gallery room. LPA tested the storage cabinets and confirmed that they were locked and secured.
Record Review and Resident/Staff Files: LPA reviewed three staff files and observed that, each staff records/file were complete and current with training and background/fingerprint clearance; per regulation. LPA reviewed 3 consumer files and found that 2 out of 3 consumer file was complete with current Needs and Services Plans, Physician Reports, and Individual Programs Plans completed by the facility and/or Inland Regional Center. One consumer was missing a current Physician report with TB results and signature. A technical violation will be issued.

Based on observations and record reviews, a technical violation will be issued to address the medical assessment report. Also, a deficiency to addressed the water temperature in the facility. An exit interview was conducted where this report was reviewed, discussed and provided to Day Program Manager Rolando Barajas.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/15/2024 12:18 PM - It Cannot Be Edited


Created By: Lavette Farlow On 11/15/2024 at 11:53 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: UNLIMITED QUEST INC
FACILITY NUMBER: 366408345

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observations, the licensee did not comply with the section cited above by not maintaining hot water temperatures in 3 out of 4 bathrooms within 105 to 120 degrees; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/19/2024
Plan of Correction
1
2
3
4
The Licensee shall provide proof to the licensing agency that the water temperatures are with regulation and receipt of new water heater if required by POC date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Lavette Farlow
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4