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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425628
Report Date: 08/18/2022
Date Signed: 08/18/2022 10:58:46 AM

Document Has Been Signed on 08/18/2022 10:58 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:BRIDGET BARCUS ARF IIFACILITY NUMBER:
366425628
ADMINISTRATOR:BARCUS, BRIDGETFACILITY TYPE:
735
ADDRESS:19664 SYMERON RD.TELEPHONE:
(760) 242-1839
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 4CENSUS: 4DATE:
08/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Nancy MaldonadoTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Anna Bueno arrived at the facility at 9:42 PM to conduct an unannounced annual required visit, with an emphasis on infection control. LPA met with direct support staff (DSP) Nancy who phoned administrator Bridget Barcus. Administrator Barcus arrived to the facility shortly.

LPA and DSP toured the facility inside and out. The facility has no bodies of water. The facility has operating smoke alarms and carbon monoxide detector. Fire extinguishers were last inspected on 7/27/2022. Medication and client files were kept secured and locked. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. Cleaning and laundry material are inaccessible to clients. 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. LPA was screened upon entry. 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. The facility keeps a schedule for cleaning and disinfecting common rooms and frequently touched areas.

LPA Bueno observed no health and safety concerns at the time of visit. The facility appears clean and tidy. Based on observations made during today’s inspection, the facility appears to be meeting operational compliance and no deficiencies are cited per Title 22, Division 6, of the California Code of Regulations.

A Technical Assistance (TA) was issued to remind staff of the importance of wearing face covering. An exit interview was conducted where this report was discussed and a copy of this report was provided to Ms. Barcus at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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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