366410678-2-14-2024-56-AS-ABUO-D2G2EP-20240214162015

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366410678
Report Date: 02/14/2024
Date Signed: 02/14/2024 04:20:28 PM

Document Has Been Signed on 02/14/2024 04:20 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME:	CANYON HILLS CARE HOME		FACILITY NUMBER:	366410678
ADMINISTRATOR:	MELJORIE CASTELO		FACILITY TYPE:	740
ADDRESS:	7791 STEWART ROAD		TELEPHONE:	(909) 433-0612
CITY:	COLTON	STATE: CA	ZIP CODE:	92324
CAPACITY:	6	CENSUS: 5	DATE:	02/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Meljorie Castelo		TIME COMPLETED:	04:21 PM

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility for a required annual inspection. Entry into the facility is unobstructed and LPA met with two facility staff who were informed of the reason for today's visit. Licensee Meljorie Castelo arrived shortly during today's visit. The facility is approved to lock two backyard gates by the Riverside County Fire Department. LPA and staff toured the facility.

Physical Plant: The facility is operating within capacity and not beyond the conditions of the license. There are no pools or other bodies of water located on the premises. The facility is being maintained at a comfortable temperature for residents. All passageways are kept free of obstruction. Hot water temperature was measured in five units at and random all measured within regulatory limits. There are grab bars for all toilets and shower used by residents. Fire safety installations such as extinguishers were last inspected on 12/14/23 and fire alarms and carbon monoxide were tested by staff. All units were found to be in working order. Overall the facility is in good condition; it is clean, sanitary and free of foul odors.

Kitchen and Food Service: The total daily diet provided to residents appears to be of the quality and in the quantity necessary to meet resident needs. There is a one week supply of nonperishable foods and two days of perishable food items. Plates, cups, and utensils were observed stored in a safe matter. All readily perishable food or beverages capable of micro-organism growth are being stored in covered containers at appropriate temperatures. Refrigerator and freezer are maintained within regulatory temperatures.

Medication, Care, and Supervision: The facility has ensured sufficient and competent staff to provide the services needed to meet resident needs. Chemicals and items which can constitute a danger are stored inaccessible to residents. LPA Bueno inspected medications and centralized list. Medications are in their original containers and appear to be dispensed according to physician's orders.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: CANYON HILLS CARE HOME	FACILITY NUMBER: 366410678
	VISIT DATE: 02/14/2024

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Resident and Staff Files: LPA Anna Bueno reviewed a sample of staff and resident files. Staff files had the required documentation including a health screening report and current first aid and/or CPR certification. Resident files had the required documentation including admission's agreement, Individual program plans, and updated physician's reports. Current first Aid/CPR training are on file and training for proper care for restricted health conditions are present.

Operations and Administration: Disaster Plan is present. Licensee is present in the facility a sufficient amount of hours and their administrator certification is up to date. The required licensing and ombudsman posters are posted in public view. Residents rights are posted and a copy is kept the resident's file.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Licensee Meljorie Castelo.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC809 (FAS) - (06/04)

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