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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425793
Report Date: 02/08/2024
Date Signed: 02/08/2024 12:08:14 PM

Document Has Been Signed on 02/08/2024 12:08 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:VALLEY STAR CRISIS RESIDENTIAL TREATMENT-THE STAYFACILITY NUMBER:
366425793
ADMINISTRATOR:RUDY ARMENDARIZFACILITY TYPE:
772
ADDRESS:780 E. GILBERT ST.TELEPHONE:
(909) 763-4760
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14CENSUS: 11DATE:
02/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rudy Armendariz, LVNTIME COMPLETED:
12:09 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the conduct a required annual inspection. LPA initially met with staff clinician and staff therapist. Program Administrator Rudy Armendariz arrived during the visit.

LPA walked the exterior of the facility while LPA and staff toured the inside. LPA observed fire extinguishers are charged and last inspected on 12/12/2023. This facility is equipped with a fire alarm and sprinkler system that is tested and maintained by the County of San Bernardino authorized fire inspection agency. LPA tested carbon monoxide detector in the kitchen area and it was found to be in working order. LPA observed there are no pools or bodies of water at this facility. LPA was informed there are no firearms or ammunition stored at the facility.

The following were observed of the physical plant:
Client Bedrooms and Bathroom: LPA and staff observed sampled bedrooms to have the required bedding and furniture, such as, mattresses/linen, sufficient and secured storage spaces, chairs, and lighting. LPA observed bathrooms to be clean. Water temperature was tested and measured to be within regulation. Provisions for hygiene items, extra clothing, and linen are available but secured.
Kitchen and Storage Areas: LPA and staff inspected the kitchen and found dishes, glasses, and utensils were stored in a safe manner. LPA inspected food provisions and found at least at 7-day supply of non-perishable food items and 2-day supply of perishable food. Storage areas hold chemicals and other supplies, including emergency supplies. Storage areas are kept locked and inaccessible to clients. Modified diets and food allergen lists are posted.
Common (living/activity) areas: LPA and staff observed adequate seating in the common areas. LPA observed sufficient activities in designated areas. Clients have access to devices to discuss personal and confidential information privately. A schedule of activities was reviewed.

The following records were inspected:
Client Records: LPA and staff inspected two client files and found all to have the required documentation, including but not limited to, admissions agreement and medical/nursing assessments.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: VALLEY STAR CRISIS RESIDENTIAL TREATMENT-THE STAY
FACILITY NUMBER: 366425793
VISIT DATE: 02/08/2024
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Staff Records: LPA reviewed three staff files. Administrator certificate is current. Training logs, include abuse recognition and prevention, was reviewed. Emergency and disaster plan is available. The last disaster drill was completed on 01/24/2024.
Centralized Medication: LPA and staff reviewed client medications list. LPA observed medication, including PRN, appear to be administered as prescribed.

No deficiencies were cited during today's visit. An exit interview was conducted with administrator Armendariz where this report was discussed and a copy was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
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