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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425616
Report Date: 01/10/2024
Date Signed: 01/10/2024 11:50:01 AM

Document Has Been Signed on 01/10/2024 11:50 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:COLE VOCATIONAL SERVICES ONTARIO BMPFACILITY NUMBER:
366425616
ADMINISTRATOR:RACHEL STEWARDFACILITY TYPE:
775
ADDRESS:3311 SHELBY STTELEPHONE:
(909) 483-0067
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 60CENSUS: 30DATE:
01/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Tiffany JohnstonTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Program Director Tiffany Johnston and was granted entry to the facility. At the time of the visit there was twelve (12) staff present, and twenty eight (28) clients present. The facility is an Adult Day Program (ADF) Licensed capacity is (60) current census (30). LPA was accompanied by Program Director, to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: Adult Day Program is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. Program facility is maintained at a comfortable temperature. LPA inspected 8 activity rooms, restrooms, changing room,kitchen area, along with back patio area. all rooms were clean, and appliances were operating appropriately. 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, 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 for clients in care.

Food Service: At the Day Program clients bring their own food, go out and buy food, or the facility provides snacks for clients based on allergies and dietary needs.

Care & Supervision: Facility has sufficient care staff for coverage five (5) days a week six hours a day. All staff members working in the facility have criminal record clearance through the department.



Record Review: LPA reviewed six (6) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COLE VOCATIONAL SERVICES ONTARIO BMP
FACILITY NUMBER: 366425616
VISIT DATE: 01/10/2024
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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 Program Director Tiffany Johnston.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
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