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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425634
Report Date: 09/18/2023
Date Signed: 09/18/2023 03:59:06 PM

Document Has Been Signed on 09/18/2023 03:59 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:PLUM LANE LEARNING CENTERFACILITY NUMBER:
366425634
ADMINISTRATOR:ANNALISA SIALANAFACILITY TYPE:
775
ADDRESS:1711 PLUM LANE, UNIT CTELEPHONE:
(909) 798-4003
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 30CENSUS: 29DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Annalisa Sialana, AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced required annual visit to the facility. LPA met with Annalisa Sialana, Administrator, and discussed the purpose of the visit.

The facility is an Adult Day Program with a license capacity of 30 and a current census of 29 clients. No clients were present during LPA's visit. LPA conducted an overall inspection, which included, but was not limited to the following:


The program facility is in good repair and operating at a comfortable temperature. Facility passageways are clear and free of obstructions. Facility has sufficient space for clients activities. Client activities include arts and crafts, board games, basketball, and watching movies.
LPA inspected client bathrooms. Bathrooms are operating in a clean and sanitary condition. The hot water temperature in bathrooms tested between 105 and 110 degrees F.
LPA inspected facility kitchen. Kitchen is clean and free of odors. Snacks are accessible to clients and stored in a healthful manner.
The facility has operating telephone services on the premises. Emergency telephone number, evacuation plans and personal rights are posted in a common area. Facility evacuation drill was conducted on 7/21/23. Facility has a complete first aid kit. Facility has sufficient personal protective equipment and personal hygiene products for clients in care. Disinfectants and cleaning solutions are kept locked and inaccessible to clients in care.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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: PLUM LANE LEARNING CENTER
FACILITY NUMBER: 366425634
VISIT DATE: 09/18/2023
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LPA reviewed (4) staff records which had criminal record clearance, first aid/CPR training, and health screenings.
LPA reviewed (4) client records which had admissions’ agreements, personal rights, emergency contacts, health screenings, and Individual Program Plans (IPP's).
An exit interview was conducted and a copy of this report was provided to the administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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