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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413246
Report Date: 01/03/2023
Date Signed: 01/03/2023 01:59:23 PM


Document Has Been Signed on 01/03/2023 01:59 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 INNFACILITY NUMBER:
366413246
ADMINISTRATOR:BARBER, DONALDFACILITY TYPE:
740
ADDRESS:17738 FRANCESCA ROADTELEPHONE:
(760) 245-2999
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:185CENSUS: 113DATE:
01/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Donald Barber, AdministratorTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Amber Coleman made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA identified self to Staff #1 (S1) and discussed the purpose of the visit. Prior to entry, facility S1 ensured that LPA was masked and had temperature taken by kiosk at the front. LPA observed the Kiosk taking photos, temperature and required all visitors to sign in via QR code. LPA was later greeted by Administrator Donald Barber on the first floor, who also provided LPA with walk through facility and a quiet place to work Administrator reports 1 case for COVID at this time.

During the inspection, LPA interviewed Administrator pertaining to the facility's infection control measures and other health and safety concerns. LPA observed necessary signs posted throughout facility, including signs related to COVID-19, which were in accordance with the Department's guidelines. Administrator reports that the facility is equipped with sufficient PPE, hand hygiene supplies, and sufficient cleaning/disinfecting provisions. The facility has a designated infection control lead person which is their Client Services Director and has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation of residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. All staff and resident restrooms were observed to contain adequate hand soap and paper supplies.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
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 INN
FACILITY NUMBER: 366413246
VISIT DATE: 01/03/2023
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Fire Drills are conducted on a monthly basis. Last drill conducted 11/30/2022 at 10am and 3:20pm.

Inspection Tool was utilized, Mitigation plan was reviewed. Facility was further inspected, and no deficiencies were noted
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2023
LIC809 (FAS) - (06/04)
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