366413072-7-11-2024-56-AS-BALN-D73PR8-20240711113219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366413072
Report Date: 07/11/2024
Date Signed: 07/11/2024 11:33:25 AM

Document Has Been Signed on 07/11/2024 11:33 AM - 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:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	366413072
ADMINISTRATOR:	CARLTON, KENYA		FACILITY TYPE:	740
ADDRESS:	2985 NORTH G STREET		TELEPHONE:	(909) 883-7703
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	97	CENSUS: 82	DATE:	07/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kenya Carlton-Administrator		TIME COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Administrator Kenya Carlton. The facility is a Residential Care Facility for Elderly (RCFE). Licensed capacity is (97) current census (82). LPA was accompanied by Facility Administrator Kenya Carlton, to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately.

LPA observed sufficient furniture and lighting throughout the facility. The facility is equipped with operating smoke detectors, carbon monoxide alarms and fire extinguishers. Posters such as personal rights, CCL complaint poster, and the disaster plan were posted in a common area.

Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated storage space for client/staff files.

Medications are kept in Med-Room inaccessible to clients. Medications were audited at random and appeared to be dispensed appropriately by staff members.

Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care.

Record Review: LPA reviewed five (5) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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: VILLAS AT SAN BERNARDINO	FACILITY NUMBER: 366413072
	VISIT DATE: 07/11/2024

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Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809) was discussed and provided to Kenya Carlton Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC809 (FAS) - (06/04)

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