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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366423857
Report Date: 05/03/2023
Date Signed: 05/03/2023 11:03:37 AM

Document Has Been Signed on 05/03/2023 11:03 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MCKINLEY CARE HOMEFACILITY NUMBER:
366423857
ADMINISTRATOR:APRILLELYN PANALIGANFACILITY TYPE:
735
ADDRESS:9895 MCKINLEY ST.TELEPHONE:
(909) 910-4633
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 4CENSUS: 3DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Aprillelyn PanaliganTIME COMPLETED:
11:15 AM
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 Licensing Program Analyst (LPA) Victoria Chitgian arrived unannounced to the facility for a required annual inspection. Facility is an Adult Residential Facility licensed for four (4) non-ambulatory clients. LPA met with Administrator Aprillelyn Panaligan . At the time of the visit, two (2) clients were present at the facility, one (1) away at Day Program.
LPA toured the facility inside and outside. Outdoor and indoor passageways were kept free of obstruction. The facility has charged fire extinguishers, operating fire alarm systems, and carbon monoxide detectors. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. LPA toured the client bedrooms. The client bedrooms had the required furniture and functional lighting. The facility had a supply of additional linen and extra hygiene items for the clients. The facility had a complete first aid kit available and the last disaster drill was conducted on 4/22/2023. Cleaning supplies, medications, and sharps were kept locked and inaccessible to the clients. Cleaning supplies were stored in the storage and laundry areas. Centrally stored medications were kept in a safe and locked cabinet. LPA toured the client bathrooms. LPA measured the hot water temperature in the bathrooms and kitchen. The hot water temperature in the client bathroom measured 113 degrees Fahrenheit. LPA observed emergency supplies in the garage. The outside of the facility had a shaded area with a table and chairs. The facility pool is gated and locked, inaccessible to clients with a fenced perimeter.
LPA reviewed staff and client files. Staff files had the required documentation including a health screening report and first aid/CPR certification. Administator file was reviewed and is complete with all required components. Client files had the required documentation including an admission's agreement, updated physician's reports, and appraisal/needs & services plans. LPA observed Client 1’s placement checklist lacked the required “No objection to placement” component. Administrator stated she will follow up with Inland Regional Center Coordinator. Technical Violation was issued.

**Continued on LIC 809-C**


SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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: MCKINLEY CARE HOME
FACILITY NUMBER: 366423857
VISIT DATE: 05/03/2023
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LPA reviewed medications. Medications were dispensed appropriately according to the physician's orders. Licensee has secured each consumer’s personal property and cash resources. All required signs and postings were visible in a common area. LPA reviewed the Emergency and Disaster Plan. LPA observed the floor plan did not have the evacuation site in the sketch, as required. Technical Violation was issued. Sufficient staff are employed and present in the facility to meet the needs of the consumers in care.

Two(2) technical violations issued during todays visit. An exit interview was conducted where this report, LIC 809, and LIC 9182 was discussed and provided to the Administrator, Aprillelyn Panaligan at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
LIC809 (FAS) - (06/04)
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