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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426118
Report Date: 11/20/2023
Date Signed: 11/20/2023 01:53:51 PM

Document Has Been Signed on 11/20/2023 01:53 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:FIRST STEP FONTANAFACILITY NUMBER:
366426118
ADMINISTRATOR:VISOR, MARYFACILITY TYPE:
775
ADDRESS:8621 JUNIPER AVE STE 101TELEPHONE:
(909) 428-6201
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 60CENSUS: 55DATE:
11/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Cecily LopezTIME COMPLETED:
02:10 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 Supervisor Cecily Lopez and was granted entry to the facility. The facility is an Adult Day Program (ADF) Licensed capacity is (60) current census (55 ). LPA was accompanied by Program Supervisor, to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected facility activity rooms; they are equipped with required furniture. LPA observed sufficient furniture and lighting throughout the facility. 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, sharps, and other dangerous items were kept inaccessible to clients in care. 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: Clients bring their own lunch however, snacks are available up on request based on on dietary/allergy needs.

Care & Supervision: Facility has sufficient care staff for coverage 5 days a week (Mon-Fri), 9:00am- 2:00pm. All staff members working in the facility have criminal record clearance through the department.


Record Review: LPA reviewed five (5) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings.

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 Supervisor Cecily Lopez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
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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