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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424416
Report Date: 06/18/2024
Date Signed: 06/18/2024 12:09:10 PM

Document Has Been Signed on 06/18/2024 12:09 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:IN-ROADS CREATIVE PROGRAMS 2FACILITY NUMBER:
366424416
ADMINISTRATOR/
DIRECTOR:		ANGELICA GARCIAFACILITY TYPE:
775
ADDRESS:9057 ARROW ROUTE, #120/#130TELEPHONE:
(909) 989-9944
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 45CENSUS: 17DATE:
06/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Marelyn Lopez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Marelyn Lopez, Administrator and was granted entry to the facility. At the time of the visit there was tsix (06) staff, and seventeen (17) clients present. The facility is an Adult Day Program (ADP) facility Licensed capacity is (45) current census (17). LPA was accompanied by Ms Lopez 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. Ms Lopez confirmed that the fire alarms and sprinklers are maintained and monitored annually by the Fire Department. Outside vendor maintain fire extinguishers. The carbon monoxide detector was tested and found to be in working order. 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. There was a designated storage space for client/staff files. Overall, the facility is clean, in good repair, and operating in safe conditions. Water temperature measures 113.4 degrees F.

Food Service: At Day Program, clients are responsible to bring their own lunch. Facility has emergency snacks, and emergency water available for clients. Dishes, cups, and utensils were also stored properly.

Care & Supervision: Day Program has sufficient care staff for coverage 6 hours Mon-Fri. All staff members working in the facility have criminal record clearance through the department.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: IN-ROADS CREATIVE PROGRAMS 2
FACILITY NUMBER: 366424416
VISIT DATE: 06/18/2024
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Record Review: LPA reviewed five (5) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings.

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 Ms Lopez.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024
LIC809 (FAS) - (06/04)
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