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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425050
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:19:48 AM

Document Has Been Signed on 10/13/2022 10:19 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:MONTE VISTA FAMILY HOMEFACILITY NUMBER:
366425050
ADMINISTRATOR:GETHERALL, JENNIFERFACILITY TYPE:
735
ADDRESS:1922 E. BROOKSIDE DRIVETELEPHONE:
(909) 930-5965
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY: 5CENSUS: DATE:
10/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Jennifer GetherallTIME COMPLETED:
10:29 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero made an unannounced visit to conduct an annual inspection, with emphasis on infection control. LPAs were greeted and allowed entrance by Direct Support Professional (DPS) Ivan De La Mora. LPAs met with Administrator Jennifer Getherall and explained the purpose of today's visit. DSP De La Mora accompanied LPAs on a tour of the facility.

LPAs toured the facility and made observations pertaining to the facility’s infection control measures. LPAs observed signage throughout the facility for proper cough etiquette, hand washing procedure, and/or social distancing guidelines. The clients have hand sanitizer available to them throughout the facility. Facility has sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs requested to inspect the facility's Personal Protective Equipment (PPE) supply and observed adequate amount of supplies. LPAs observed one central entry point and a sign-in has been designated for screening that includes temperature and symptom checks. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and clients for COVID-19, when and how to isolate/quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the client's physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses.

No deficiencies were cited during today’s visit
An exit interview was conducted, and a copy of this report was discussed and provided to Administrator Jennifer Getherall
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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