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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427612
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:11:35 PM

Document Has Been Signed on 05/16/2024 03:11 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:INNOVATIVE BUSINESS PARTNERSHIPS INCFACILITY NUMBER:
366427612
ADMINISTRATOR/
DIRECTOR:		KRAGNESS, THERESE MFACILITY TYPE:
775
ADDRESS:17185 YUMA STREETTELEPHONE:
(760) 243-1400
CITY:VICTORVILLESTATE: CAZIP CODE:
92393
CAPACITY: 165CENSUS: 84DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Therese M. Kragness-AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:17 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Echeverria conducted an unannounced required Annual Inspection. LPA identified herself to Administrator, Therese Kragness who was advised of the purpose of the visit. The facility is currently licensed as an Adult Day Program and has 68 clients present, 6 remote and 10 absent. LPA was accompanied by Administrator to conduct a general overall inspection, which included, but was not limited to, the following:

LPA inspected the facility inside and outside. LPA observed all passageways are clear of obstructions. The facility is maintained at a comfortable temperature of 72, 72, and 74 degrees fahrenheit. LPA inspected client activity rooms; they are equipped with required furniture and activity supplies/equipment for clients. LPA inspected client bathrooms; bathroom appliances were operating in good and sanitary conditions. LPA observed grab bars in the bathrooms. LPA observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 109 and 109.8 degrees fahrenheit. Disinfectants, toxins, sharps and cleaning supplies are locked and inaccessible to clients. There are no firearms/ammunition or bodies of water.

At Day Program, clients are responsible to bring their own lunch. Snacks are made available. LPA observed the refrigerator not maintained in sanitary conditions where 3 dozen of expired eggs and moldy cheese was found. Deficiency issued.

LPA observed sufficient staff present for the number of clients in care. Medication is locked and inaccessible to clients in the facility. LPA observed fire extinguishers, smoke alarms, carbon monoxide alarms, and first aid kit in the facility. The last disaster drill was conducted on 6/5/23. Deficiency issued.

LPA reviewed six (6) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed five (5) staff files along with the administrator's file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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: INNOVATIVE BUSINESS PARTNERSHIPS INC
FACILITY NUMBER: 366427612
VISIT DATE: 05/16/2024
NARRATIVE
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LPA observed missing LIC508 in the personnel record for S1, S2 and S3. Administrator stated that the forms were not required per law effective January 2023. Deficiency issued. LPA observed the Infection Control Plan not reviewed annually since 08/18/22. Technical Assistance issued.

Based on the observations made during today’s visit, deficiencies and one technical assistance were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report LIC809, LIC809C, LIC809D, LIC9102TA and appeal rights were discussed and provided to Administrator, Therese Kragness..

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/16/2024 03:11 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 05/16/2024 at 01:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: INNOVATIVE BUSINESS PARTNERSHIPS INC
FACILITY NUMBER: 366427612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82023(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the administrator did not comply with the section cited above in conducting disaster drills every six months per last drill conducted on 06/05/23 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2024
Plan of Correction
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Administrator stated that she will submit a statement of understanding on the regulation cited and submit proof to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/16/2024 03:11 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 05/16/2024 at 02:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: INNOVATIVE BUSINESS PARTNERSHIPS INC
FACILITY NUMBER: 366427612

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82019(d)
82019(d) Criminal Record Clearance
All individuals subject to a criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC508) under penalty of perjury with the following information. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the administrator did not comply with the section cited above in having a LIC508 included in the personnel record for S1, S2, S3 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2024
Plan of Correction
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Administrator stated that she will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
Type B
Section Cited
CCR
82087(a)
82087(a) Buildings and Grounds
The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-bein of clients, employees and visitors. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the administrator did not comply with the section cited above in maintaining the client's refrigerator sanitary in which expired eggs and moldy and expired cheese was stored which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/23/2024
Plan of Correction
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Administrator had a staff remove the unsanitary food inside the refrigerator. Administrator stated that she will hold a training with staff and submit proof to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
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