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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600519
Report Date: 06/15/2023
Date Signed: 06/15/2023 06:36:39 PM

Document Has Been Signed on 06/15/2023 06:36 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALTA VISTA HOMEFACILITY NUMBER:
374600519
ADMINISTRATOR:LUZVIMINDA CABADINGFACILITY TYPE:
735
ADDRESS:1975 ALTA VISTA DRIVETELEPHONE:
(760) 758-4888
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 6CENSUS: 6DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Miriam SilvaTIME COMPLETED:
06:35 PM
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA Shaw Ross met with Executive Director, Miriam Silva and explained the nature of the visit and was granted entry into the facility. The facility was inspected inside and out. At the time of the visit, three staff and six clients were noted to be present.

The facility is one story with four bedrooms and two bathrooms. Two of the bedrooms are shared with two clients in each bedroom. The other two clients have their own bedrooms. Client bedrooms were observed to be clean and appropriately furnished. The facility appears clean and free of odors. Food supplies are sufficient. LPA Shaw Ross observed all toxic chemicals and other hazards secured and inaccessible to clients. Hot water was tested and deemed safe at 123.9 degrees. All smoke and carbon monoxide detectors were tested and found operable. Medications are centrally stored in a locked cabinet in the kitchen. P&I funds are stored in a safe in the staff office and are maintained separately from facility funds. Furniture in the facility is in good repair. Outdoor space is free of hazards.

LPA Shaw Rossinspected the staff and client records. Staff present have criminal record clearances and are appropriately associated to the facility. Staff files had the required documentation including First Aid Certifications and training documents. LPA confirmed the administrator paid and requested for a new administrator's certificate. Client records were reviewed and IPPs were observed to be up to date. LPA inspected medications and medications appear to be dispensed appropriately according to the physician's orders. The facility is completing emergency drills as needed. Staff and client interviews were conducted.

During the inspection, no deficiencies were observed.
An exit interview was conducted and a copy of the report and LIC 811 was provided to the Executive Administrator, Miriam Silva.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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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