366413245-1-10-2024-56-AS-MECA-CZD272-20240110160800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366413245
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:08:07 PM

Document Has Been Signed on 01/10/2024 04:08 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 COMMONS		FACILITY NUMBER:	366413245
ADMINISTRATOR:	DEBORAH STAGGS		FACILITY TYPE:	740
ADDRESS:	17797 LINDERO ROAD		TELEPHONE:	(760) 245-3300
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	70	CENSUS: 58	DATE:	01/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Shelia Orozco- Director of Resident Services		TIME COMPLETED:	04:12 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 Director of Resident Services, Shelia Orozco and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) licensed capacity for (70) nonambulatory, hospice waiver for (15), bedridden for (35), fire clearance for delayed egress and locked perimeters and advertising in dementia care. The facility has (3) wings, (39) bedrooms, bathrooms, reception area, living rooms, tv rooms, kitchen, laundry room, staff rooms, offices and shaded patios. LPA was accompanied by Shelia 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, 73, 75, 68.2, 73, 72 and 75 degrees fahrenheit. Water temperature measured at 109.1, 106.8, 105, 105.4 and 105.2 degrees fahrenheit. LPA inspected resident 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 fire extinguishers, smoke detectors, signal alarms and carbon monoxide alarms. Posters such as personal rights, CCL complaint poster, CCL license, ombudsman, and facility sketch were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for residents/staff files. Medications were kept inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care.

Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Pesticides and other toxin's are not stored in food areas.

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.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Michelle Echeverria	TELEPHONE: 951-248-0345
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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: STERLING COMMONS	FACILITY NUMBER: 366413245
	VISIT DATE: 01/10/2024

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Record Review: LPA reviewed (4) residents files for admission agreements, physician reports, and needs and services plans. LPA also reviewed (4) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were not audited due to time management.

No deficiencies were cited during this visit. An exit interview was conducted, and this report LIC809 and LIC809C were discussed and provided to Director of Resident Services, Shelia Orozco.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Michelle Echeverria	TELEPHONE: 951-248-0345
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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