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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413072
Report Date: 06/21/2022
Date Signed: 06/21/2022 11:57:04 AM


Document Has Been Signed on 06/21/2022 11:57 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 BERNARDINOFACILITY NUMBER:
366413072
ADMINISTRATOR:TOMI MORALESFACILITY TYPE:
740
ADDRESS:2985 NORTH G STREETTELEPHONE:
(909) 883-7703
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY:97CENSUS: 83DATE:
06/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for a required annual inspection, with an emphasis on the infection control domain. LPA met with administrator Tomi Morales who confirmed there are no active and/or suspected Covid-19 cases in the community. LPA toured the facility with Administrator.

The facility submitted a mitigation plan to Community Care Licensing (CCL) to mitigate the spread of COVID-19 in the facility. Single entry point to the main lobby has a sign-in policy for universal entry screening. The facility also documents daily temperature and COVID-19 symptom checks for all visitors and staff while residents are subject to routine symptom screening and regular observations for any change in condition. Continued weekly routine testing for staff is still observed. LPA observed all staff are properly fitted with face coverings. Morales also confirmed the facility has an adequate supply of cleaning and disinfectant provisions.

LPA Bueno and Administrator Morales toured the facility’s common rooms. Morales confirmed that a daily deep clean is conducted and common surfaces are sanitized least twice a day and after every use when there are active cases. Maintenance Director stated that an outside vendor maintains the fire alarms, kitchen fire suppressants, sprinkler systems. Maintenance Director confirmed that the facility monitors the smoke detectors and carbon monoxide alarms. The facility was last inspected by the local Fire Marshall on 2/17/2022.

Based on observations made during today’s inspection, this facility is meeting operational compliance. 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 with, and a copy was provided to Administrator Morales at the conclusion of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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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