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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413136
Report Date: 10/29/2024
Date Signed: 10/29/2024 01:17:37 PM

Document Has Been Signed on 10/29/2024 01:17 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:STERLING COMMONSFACILITY NUMBER:
366413136
ADMINISTRATOR/
DIRECTOR:
DONALD BARBERFACILITY TYPE:
775
ADDRESS:17797 LINDERO ROADTELEPHONE:
(760) 245-3300
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 15CENSUS: 2DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Debbie Staggs- Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
01:32 PM
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Licensing Program Analyst (LPA) Michelle Echeverria made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Executive Director Debbie Staggs and was granted entry to the facility's meeting room. LPA was accompanied by Debbie 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, 74 degrees fahrenheit. Posters such as personal rights, the CCL complaint poster, and the long term ombudsman were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents. There was a designated storage space for resident/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions.

Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a variety of food available for residents. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Day Program has sufficient care staff for coverage.

Record Review: LPA reviewed resident file for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings. The last fire drill was conducted on 9/4/24.

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 provide to Executive Director, Debbie Staggs.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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