366424321-11-1-2024-56-AS-BSIH-DALS8D-20241101133859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366424321
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:39:06 PM

Document Has Been Signed on 11/01/2024 01:39 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	LMB CARE HOME		FACILITY NUMBER:	366424321
ADMINISTRATOR/ DIRECTOR:	BRANDON DELGADO		FACILITY TYPE:	735
ADDRESS:	1813 N. CALAVERAS AVENUE		TELEPHONE:	(909) 256-3194
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91764
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	11/01/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	Facility Caregiver Zanaida Sabado		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

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Licensing Program Analyst (LPAs) Beena Singh and Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Facility Caregiver Zanaida Sabado and was granted entry to the facility. At the time of the visit there were two (2) staffs present, two clients were attending Day Program. The facility is a five (5) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, and detached garage. The facility is an Adult Residential Facility (ARF) Level 2 home, vendorized by Inland Regional Center. Licensed capacity is (6) current census (2). LPA Beena Singh was accompanied by Facility Caregiver, 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. LPA Beena Singh inspected client's bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Beena Singh observed sufficient furniture and lighting throughout the facility. LPA Beena Singh measured and observed the water temperatures in the bathrooms to be 105 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated storage space for client/staff files. Medications are kept inside filling cabinet inaccessible to clients in care. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care.

(Continued in LIC809C)

Efren Malagon	TELEPHONE: (951) 202-6356
Beena Singh	TELEPHONE: (951) 248-2222
	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LMB CARE HOME	FACILITY NUMBER: 366424321
	VISIT DATE: 11/01/2024

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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.

Record Review: LPA Beena Singh reviewed two (2) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members.

P&I funds were counted for and matched with the ledger.

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 provided to Facility Caregiver

Zenaida Sabado.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Beena Singh	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024

LIC809 (FAS) - (06/04)

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