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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366412371
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:46:04 PM

Document Has Been Signed on 08/18/2022 12:46 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:BRIDGET BARCUS ARFFACILITY NUMBER:
366412371
ADMINISTRATOR:BARCUS, BRIDGETFACILITY TYPE:
735
ADDRESS:15540 CHOLE RDTELEPHONE:
(760) 242-4230
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 4CENSUS: 4DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Bridget Barcus, administratorTIME COMPLETED:
12:49 PM
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Licensing Program Analyst (LPA) Anna Bueno arrived at the facility to conduct an unannounced annual required visit, with an emphasis on infection control. LPA met with administrator Bridget Barcus and direct support staff.

LPA and Administrator toured the facility inside and out. The facility has no bodies of water. The facility has operating smoke alarm and carbon monoxide detector. Medication and client files were kept secured and locked. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The client bedrooms had the required furniture and sufficient lighting.

LPA Bueno observed one central entry point and sign-in policy has been designated for screening. LPA was screened upon entry. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate and quarantine clients. The facility keeps a schedule for cleaning and disinfecting common rooms and frequently touched areas.

LPA Bueno observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, the facility appears to be meeting operational compliance and no deficiencies are cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed and a copy of this report was provided to Ms. Barcus at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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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