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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808597
Report Date: 11/17/2023
Date Signed: 11/17/2023 01:59:41 PM

Document Has Been Signed on 11/17/2023 01:59 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:STONE MOUNTAIN RANCHFACILITY NUMBER:
370808597
ADMINISTRATOR:ROBINSON, DEZIFACILITY TYPE:
735
ADDRESS:16585 HIGHLAND VALLEY ROADTELEPHONE:
(760) 789-4600
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 15CENSUS: 13DATE:
11/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Director, Dezi RobinsonTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA were welcomed by, identified herself to, and discussed the purpose of the visit with Administrator, Dezi Robinson.

According to the facility’s license, the facility has a maximum capacity of fifteen (15) clients, all of whom are non-ambulatory. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Administrator, Dezi Robinson. toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was complainant. Hot water temperature at taps accessible to clients were all compliant.

Refrigerator and Freezer temperature were complaint. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.


[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: STONE MOUNTAIN RANCH
FACILITY NUMBER: 370808597
VISIT DATE: 11/17/2023
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[CONTINUED FROM LIC 809]


There is a pool on site made inaccessible to clients by a fence and locks. Per Administrator Robinson, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Administrator Robinson also presented proof of current/active business liability insurance.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with, Administrator, Dezi Robinson to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
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