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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426710
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:27:44 PM


Document Has Been Signed on 07/24/2024 03:27 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:LINDA VALLEY ASSISTED LIVINGFACILITY NUMBER:
366426710
ADMINISTRATOR:EILEEN SANCHEZFACILITY TYPE:
740
ADDRESS:25393 COLE ST.TELEPHONE:
(909) 799-3117
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:64CENSUS: 57DATE:
07/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mayra Alfaro - Resident Services CoordinatorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Magda Malcore made an unannounced required annual visit to the facility. LPA met with Mayra Alfaro, Resident Services Coordinator (RSC), and discussed the purpose of the visit. LPA conducted an overall inspection of facility, which included, but was not limited to, the following:

Physical Plant: The facility has a license capacity of (64) and a current census of (57). Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming pool or similar bodies of water. The facility has sufficient indoor and outdoor space for resident activities. The facility is maintained at a comfortable temperature. Resident bedrooms were furnished with beds, bed linen, night stands, storage space, and sufficient lighting. Resident bathrooms were maintained clean and fixtures were operating properly. The hot water temperatures in the bathrooms measured at 107 degrees F. The facility is equipped with operating signal alarms, carbon monoxide alarms, and telephone service. The facility has posted in a common area: Community Care Licensing complaint poster, Ombudsman poster, facility license, facility sketch, resident activities, and menus. Medications were labeled and centrally stored in a locked area.

Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care.

Care & Supervision: The facility has care staff coverage, 24 hours a day, 7 days a week.

Record Review: Five (5) resident files were observed to be complete. Five (5) staff files reviewed were observed to be complete and include criminal record clearances through the Department. The Administrator's certification is current and the last fire drill was conducted in April 2024.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024
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: LINDA VALLEY ASSISTED LIVING
FACILITY NUMBER: 366426710
VISIT DATE: 07/24/2024
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Based on LPA observations and records reviewed, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where this report (LIC809) was discussed and a copy provided to the RSC at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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