<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425834
Report Date: 11/22/2024
Date Signed: 11/22/2024 01:13:40 PM

Document Has Been Signed on 11/22/2024 01:13 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:FOREMOST SENIOR CAMPUSFACILITY NUMBER:
366425834
ADMINISTRATOR/
DIRECTOR:		DANICA TURNERFACILITY TYPE:
740
ADDRESS:17581 SULTANA STREETTELEPHONE:
(760) 244-5579
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 82DATE:
11/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Danica Turner - AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Magda Malcore conducted a case management visit at the facility. LPA met with Administrator Danica Turner, and discussed the purpose for the visit.
LPA conducted a tour of wing #2 accompanied by two (2) staff and attempted to interview resident #1 (R1). Staff knocked on the door and announced themselves before entering the room. Upon opening the door, LPA observed a strong odor in the room. LPA informed the Administrator and had housekeeping clean R1's room. LPA returned to R1's room and observed housekeeping cleaning the carpet.

Based on LPAs observations, a deficiency is being cited in accordance with Title 22, of the California Code of Regulations.

An exit interview was conducted where this report was discussed. A copy of this report with appeal Rights was provided to the Administrator at the conclusion of the visit.
Karen ClemonsTELEPHONE: (951) 248-0349
Magda MalcoreTELEPHONE: 951-248-0316
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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
Document Has Been Signed on 11/22/2024 01:13 PM - It Cannot Be Edited

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: FOREMOST SENIOR CAMPUS
FACILITY NUMBER: 366425834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
POC Due Date: 11/23/2024
Plan of Correction
1
2
3
4
LPA observed resident's room was being cleaned by housekeeping. No further action required.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karen ClemonsTELEPHONE: (951) 248-0349
Magda MalcoreTELEPHONE: 951-248-0316

DATE: 11/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2024

LIC809 (FAS) - (06/04)
Page: 2 of 2