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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425515
Report Date: 08/03/2022
Date Signed: 08/03/2022 01:56:58 PM

Document Has Been Signed on 08/03/2022 01:56 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:DAYBREAK CARE HOMEFACILITY NUMBER:
366425515
ADMINISTRATOR:CALDERON, GRACIELAFACILITY TYPE:
735
ADDRESS:15446 DAYBREAK LANETELEPHONE:
(909) 452-7178
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 6CENSUS: 3DATE:
08/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Graciela CalderonTIME COMPLETED:
01:59 PM
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Licensing Program Analyst (LPA) Anna Bueno arrived at the facility at 1:01 PM to conduct an unannounced annual required visit, with an emphasis on infection control. LPA met with live in direct support staff who phoned licensee Graciela Calderon. LPA advised licensee of the nature of the visit and was granted entry to the facility.

LPA and Licensee toured the facility inside and out. The facility has no bodies of water. The facility has operating smoke alarms and carbon monoxide detector and charged fire extinguisher. Medication and client files were kept in a locked room. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The client bedrooms had the required furniture and sufficient lighting.

LPA Bueno observed one central entry point and sign-in policy has been designated for screening. Symptom screening has been initiated for all visitors. Client temperatures are taken daily. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate and quarantine clients, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas.

LPA Bueno observed no health and safety concerns at the time of visit. The facility appears to be meeting operational compliance. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed and a copy of this report was provided to Graciela Calderon at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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