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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413181
Report Date: 07/15/2024
Date Signed: 07/15/2024 12:40:24 PM

Document Has Been Signed on 07/15/2024 12:40 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:SOLANA HOUSEFACILITY NUMBER:
366413181
ADMINISTRATOR/
DIRECTOR:		BYERS, MELISSAFACILITY TYPE:
735
ADDRESS:12279 FREEPORT DRIVETELEPHONE:
(760) 949-8888
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 4CENSUS: 3DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Melissa Byers-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:46 PM
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Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator, Melissa Byers, introduced self and stated the purpose of the visit. LPA was informed that all clients are in day program.

The facility has 4 client bedrooms, 2 bathrooms, 1 staff bedroom with private bathroom, family room, kitchen, dining area, living room, loft, laundry room, attached garage, and backyard. The facility is vendorized by Inland Regional Center. LPA completed a walk through of the facility, review of records, medication and P&I audit.

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 of 78 degrees fahrenheit. LPA inspected clients bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected clients bathrooms; bathrooms were clean and appliances were functional. An adequate supply of linens and blankets stored upstairs in a cabinet in the hallway of the residence. Water temperature tested at 109.7 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, two charged fire extinguishers, first aid kit, emergency kits and emergency food. Posters such as; the personal rights, disaster plans and CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept in secure cabinets inaccessible to clients. There was a designated storage space for client/staff files and medications inside the locked closet. The facility has a working telephone line. There are no pools or bodies of water. Firearm and ammunition is locked in a safe made inaccessible to clients. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SOLANA HOUSE
FACILITY NUMBER: 366413181
VISIT DATE: 07/15/2024
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Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Three refrigerators stocked with food up to date, emergency food and water were observed inside the garage. Facility has a wide variety of food available for clients. Dishes, cups, and utensils were also stored properly.

Yards/Outside: One shaded patio, a side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions.

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. Administrator and spouse reside in the home.

Record Review: LPA reviewed client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff. P&I currency matched with ledger. The facility last conducted a fire and earthquake drill on 6/20/24. The liability insurance is current and active until 3/1/25.

No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 and LIC809C were discussed and copies were provided to the Adminstrator, Melissa Byers.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC809 (FAS) - (06/04)
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