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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424420
Report Date: 05/30/2023
Date Signed: 05/30/2023 03:50:11 PM

Document Has Been Signed on 05/30/2023 03:50 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:FAITH ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
366424420
ADMINISTRATOR:ALVARADO, FRANCIAFACILITY TYPE:
735
ADDRESS:1660 NARANJO CT.TELEPHONE:
(909) 351-6532
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 4CENSUS: 3DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Francia Alvarado, LicenseeTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Francia Alvarado, Licensee and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF), license capacity of (4) with a current census of (3). The facility has 3 client bedrooms, 2 staff bedrooms, 3 bathrooms, kitchen/dining area, living room, family room and attached garage. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways and stairways are free of obstruction. Facility has no outdoor bodies of water. The facility has sufficient indoor and outdoor furniture in good repair for clients in care. Backyard is fenced with a self-latching gate and covered patio area. The facility has sufficient lighting and is maintained at a comfortable temperature 74 degrees F.

LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of clients in care. A monthly menu is posted in the kitchen. Facility food is stored in a safe and healthful manner. Facility has sufficient cups, plates, and utensils for clients in care. Sharps are stored and kept locked and inaccessible to clients in care. Kitchen hot water tested within regulation at 111 degrees F.

LPA inspected client bedrooms. Bedrooms are equipped with required furniture in good repair such as: mattresses, nightstands, pillows, and storage space. Bedrooms have sufficient linen and lighting. LPA inspected client bathrooms. Bathrooms were equipped with handrails and operating in safe and sanitary conditions. The hot water temperature tested within regulation at 107 degrees F.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2023
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: FAITH ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 366424420
VISIT DATE: 05/30/2023
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LPA observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguishers. Fireplace adequately screened and the facility has operating telephone service. Posters such as personal rights, facility sketch, emergency phone numbers were posted in a common area. Emergency drill conducted on 3/03/2023. Cleaning supplies, toxins, items were kept locked and inaccessible to clients in care.

LPA observed client medications are kept in a safe and locked cabinet inaccessible to clients in care. All medication are labeled and administered as prescribed.

All staff files reviewed had criminal record clearance, First Aid/CPR training,and health screenings.

All client records reviewed had admissions agreements, updated physician's report, personal rights statements, needs and service plans.

Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, California Code of Regulations.

An exit interview was conducted, where this report (LIC809) was discussed and a copy of report with appeal rights was provided to the Licensee at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC809 (FAS) - (06/04)
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